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DOCTORS, in general, have a powerful voice, as we are generally trusted and respected. We are often asked to be members of boards and committees and to act as advocates.
We present learnings from a virtual half-day event on 11 September called “MBA in a Day”, presented by the Committee of Chairs of Medical Colleges in Victoria, hosted by the Royal Australasian College of Physicians and attended by over 400 doctors. The event featured senior doctors sharing their expertise and experience on various topics relating to leadership and management. This article summarises the key points, which may benefit interested readers.
Doctors leading as advocates
The word “advocacy” comes from Latin and means “to be called to stand beside”. In other words, it is the action of speaking on behalf or in support of another person, place or thing. Doctors can use their position of influence in society to be powerful advocates for issues that benefit the community. As this quote from The Lorax by Dr Seuss goes: “Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not.”
Health puts a human face to abstract concepts, and health concerns attract political and public attention. As Watts and colleagues (2015) put it: “… the health and wellbeing of our families, communities and countries. These concepts are far more tangible and visceral than tonnes of atmospheric CO2 and are understood and prioritised across all populations irrespective of culture or development status”.
Doctors have immense privilege, and this brings with it an obligation to speak out for those with less of a voice, including our more vulnerable populations, as well as future generations in the case of climate change, which has a disproportionate impact on the poor, and raises the issue of intergenerational justice. Doctors have had a long and proud history of acting against health threats, such as the abolition of slavery in 1883, the public health measures to stamp out cholera in 1854, the campaign against smoking and tobacco, or against nuclear proliferation – the list goes on.
So how do doctors get started? We can start to read and engage with issues that we personally care about. We can start talking to people about them and join groups working on these issues. We can attend short courses and undertake media training. The key is to get started. As Janna Cachola, advocacy trainer, puts it: “Advocacy is empathy, compassion and community at work.”
Doctors as board members
Doctors are attractive as members of governance boards because of the clinical expertise they bring (especially to health-related organisations) and the unique way they approach problems due to their medical training. Boards provide oversight to organisations and a role to provide governance and lead strategy. They may report to government, the membership, or shareholders, depending on the type of body they oversee, and as such there may be different requirements and skills required.
In general, depending on the organisation, boards may be responsible for the appointment, mentorship, and support of the executive management. A doctor’s experience of being a supervisor and mentor to junior members of their team may therefore be useful in this context. In addition, a doctor’s ability to integrate a lot of documented information and formulate alternative solutions to problems comes in handy as a board member, as there is usually a copious amount of reading required before attending board meetings.
The role of a board is to provide governance and oversight, and a board should not be directly involved in the management or operations of an organisation but delegate those functions to the executive team. As doctors are trained to be “doers”, this lack of direct action may be challenging in the beginning. However, doctors are trained to take a history, so one tip for new directors is to start off by asking questions about the information being provided to the board in the beginning, rather than providing direction.
In relation to finding board positions, doctors can look at related health fields, such as positions at a public health service, health insurer, community health organisations, medical research institutes or academic organisations, not-for-profits entities, or services that incorporate a health aspect. However, doctors may also choose to pursue board positions for organisations related to their personal passions or interests, such as in the arts, sports, teaching – the options are endless.
A resume that includes board-related experience, or exposure to governance-type roles, such as membership of professional society councils, would be attractive to boards seeking new members. Doctors interested in pursuing a board career should consider formal training as well; for example, with the Australian Institute of Company Directors (AICD).
Doctors and the media
Dealing with the media is an important skill for doctors, and we have essential roles as advocates and communicators to ensure we get our message across to promote health and the wellbeing of our patients and the wider community. There are a few principles that are helpful to keep in mind in this area.
First of all, when a request is received from a member of the media, the first question to consider is why you as a doctor have been contacted. What is the purpose of the request? Are you being asked for your expert opinion on a topic, or are you speaking on behalf of a body? Who are the intended audience – will you be reaching out to your own colleagues, or to the public? Lastly, what type of interview is this? Is the medium print, radio or television?
The next thing to consider is the content of the interview. Basically, what type of story are they writing? Understanding the type of story and the tone is important, as you will need to prepare for it, undertake research, and be across the issues that may be raised. Part of this planning phase is to finalise three or four key messages that you want to get across to the audience.
There are potential traps when it comes to dealing with the media for the inexperienced. One is lack of preparation and not taking the time to be ready with responses to questions that should be anticipated. The other is being tired and distracted during an interview, which can lead to having vulnerabilities that can be taken advantage of by journalists. The doctor being interviewed should understand that there is no such thing as “off the record”, and anything said in front of a microphone, camera or smartphone, even if they are meant to be switched off, may still be recorded and used by a journalist who is less than ethical.
Doctors will need specific training to handle the media well. Being involved with the media can be incredibly time consuming – you can spend many hours preparing for an interview, and wait all day for your time slot, only to have the interview cancelled at the last minute because you were bumped by a more interesting story. Or you can do an interview for 45 minutes, to have most of your time end up on the cutting floor by an editor, so that you are left as just a sound bite. Doctors will have to learn not to get frustrated by any of that as this is business as usual.
Effective committee leadership and membership
Doctors are often asked to be a member of a committee by their hospital, specialty college or specialist society because of their seniority or specific expertise; for example, to be part of an ethics committee. They may even be asked to be part of an external committee by the department of health or by a school.
It is important for the doctor to understand the type of committee they have been asked to join – is it a decision-making body or advisory? If the doctor is there representing others, then they may have an obligation to report back to that group. The terms of reference of the committee should outline the purpose, roles and responsibility, and membership, and provide guidance. It should also outline who the committee reports to, the quorum, and frequency of meetings.
The chair should try their best to make meetings interactive, and involve members through active facilitation, especially during this period when virtual meetings are becoming the norm. Discussions should be on topic, quiet members encouraged to speak, and ensure time management is a focus so that the meeting gets through its agenda on time. Ultimately, committee meetings should be enjoyable experiences not a chore, and be a meaningful part of a healthy governance process.
How to write a business case
Knowing how to develop a robust business case is an important skill for doctors who transition to leadership roles within an organisation. A business case provides justification for undertaking a project, program or portfolio, and should evaluate the benefit, cost and risk of alternative options, as well as provide a rationale for the preferred solution.
Unlike an application for a research grant, a business case is a narrative that tells a story. As such, the language used should align with the organisation and its values. It should have clear links to the organisation’s strategic plan and the whole document should be kept tight and to the point.
The first step is identifying what the problem is, and what various solutions look like. The aim is to select the best model based on how innovative it is, its scalability, and its alignment with service/organisation/patient factors, rather than simply just asking for more of something.
The business case must be clear on the costs of the project. The staffing model is a major recurrent cost, and the business case needs to be realistic about the amount of time required to do the volume of work. The capital costs of a project need to also be clarified, and these are usually one-off costs that are of high value, which includes installation and infrastructure.
The other side of a business case is to outline any expected revenue or benefits. Even if there is no direct additional income generated, there may be clinical benefits and a clinical need for the project that require to be clearly outlined and justified.
We hope you find these learnings valuable as you expand your interests beyond your consulting room.
Professor Erwin Loh is the national Chief Medical Officer for St Vincent’s Health Australia, and Vice President of the Royal Australian College of Medical Administrators.
Associate Professor Katherine Barraclough is a nephrologist at the Royal Melbourne Hospital and Board member and Victorian Chair of Doctors for the Environment Australia.
Professor Cassandra Szoeke is a neurologist and NHMRC Principal Professorial Fellow at the Royal Melbourne Hospital, and has extensive governance experience.
Dr Sarah Whitelaw is an emergency physician at the Royal Melbourne Hospital, Director at the Victorian Doctors Health Progam and Vice President of the Australian Medical Association Victoria.
Dr Katharine See is the Director of Respiratory Medicine at Northern Health. In addition to her medical qualifications she has an Executive MBA from Melbourne Business School.
Professor Judy Savige is a clinician-researcher who is Chair of the Committee of Chairs of Medical Colleges in Victoria and Chair of the Royal Australasian College of Physicians’ Victorian Regional Faculty.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.