Reflections on leadership

Phil Turner

Philip Turner is a Consultant at Stepping Hill Hospital, Stockport. He was BOA President from 2018 to 2019 and was elected to Council of the Royal College of Surgeons of Edinburgh in 2019. He was the founding Chair of the Greater Manchester Orthopaedic Alliance (GMOA) and is co-Chair of the Greater Manchester recovery CRG.

“Leadership, like swimming, cannot be learned by reading about it” – Henry Mitzberg

I am desperately trying to avoid the word ‘journey’, but there is no getting away from the concept of moving forward through leadership roles. I certainly never set out to be a leader – I just wanted to be a good surgeon. However, it was very clear from early on that good leadership made a huge positive difference to patient care and that poor leadership was incredibly destructive. At that stage I didn’t have the vocabulary to describe what I observed but I knew what worked and what didn’t.

My passion has always been medical education, so I progressed through organising regional teaching, meetings and courses, post-graduate degrees and ATLS and AO courses in the UK and overseas. I joined the training committee, became TPD and Head of School, Chair of the Confederation of Post-Graduate Schools of Surgery and IQA Chair for JCIE. Away from education, I have been Clinical Director, Chair of the Greater Manchester Orthopaedic Alliance, and Improving Surgical Care committees as well as roles with GIRFT.

Before setting out my thoughts on leadership, particularly relating to my time as BOA President, it may help to set out the pathway to achieving the highest office in the organisation.

The first step is to become an elected Trustee selected by the entire membership. This requires a profile that members recognise and a wellcrafted statement that shows you have delivered previously and clearly demonstrates what you will bring to the organisation. Election to the Presidential line is by a ballot of the Trustees so once again you must have proven you will be both safe and effective as well as having a vision of where the Association should be heading. You will be committing to at least four years on the Executive as Vice-President elect, Vice-President, President, and Immediate Past President.

The year as President

The two years run-in to President really is necessary. The organisation is complicated and the issues wide-ranging. It would be impossible for the President to simply hand over their portfolio.

The year itself is incredibly busy so the time as Vice President is when you should set out the practicalities of what you want or need to achieve. I was so lucky to be the last pre-pandemic President who had the opportunity to represent our profession across the world in person. International guests and speakers attended Congress, networks and long-standing friendships established and we could promote the best of UK orthopaedics across the globe. We were the guest nation in Germany and China along with the established ‘Carousel’ engagements with all the English-speaking Associations. BOA Council and committees had to be organised, attended, or chaired, invitations to national and international events dealt with and meetings with NHS and education bodies arranged, often at short notice. All this along with the day to day running of the BOA and keeping a clinical service going back at base.

Now my reflections on leadership. These are just a few of the lessons I have learned from experience and observation.

Learning to be a leader

Trainees, new consultants and indeed all staff should have leadership embedded in their development plans. Those choosing to take it further have access to the BOA Future Leaders Programme or NHS leadership fellowships. My initial inspiration came from reading Stephen Covey’s book ‘The Seven Habits of Highly Effective People’ and then pushing myself to take on roles that stretched my knowledge and skills. You must be willing to accept and learn from failure. A successful surgeon will influence the lives of a few thousand patients, a trainer will affect tens of thousands and perhaps dozens of trainees, but a leader can have a positive direct or indirect impact on at least hundreds of thousands of patients.

Structure your committees

Committees are a necessary component of any sizeable organisation, but they should never develop organically. They can expand when out of control, appointing people who have the same safe opinions. The members should be selected through a transparent process that ensures diversity of experience, age, knowledge, and skills to ensure all points of view are represented, there are no blind spots and much richer discussions are encouraged.

Run effective meetings

Ineffective meetings are a drain on time and effort. Every meeting must have a purpose and should never be used to list problems or grievances without also having a list of potential solutions. They must be carefully organised ensuring all participants are briefed. They should not be used for disseminating information alone but for developing plans and making decisions after full and open discussion. Chairing a meeting is always a balance of maintaining focus yet allowing or encouraging people to speak. Ensure that an action list with responsibilities is completed as the meeting concludes. This avoids the meeting after the meeting when some regard the real decisions are made. Never ‘throw your toys out of the pram’ as it makes you look foolish and wrecks the whole event.

Play to your strengths

You must be honest with yourself. You need to know what you are both good at and enjoy doing as well as where your weaknesses lie. I was fortunate to be in the Executive at a time when we had the opportunity to completely renew the structure, processes, and governance of the BOA with the appointment of a new Chief Operating Officer which was an ideal project for me. A similar skill set was needed to guide the organisation and our professional response through the early months of COVID-19. Support is always available from others – be it from the staff and officers, the sub-committees, specialist societies and particularly (for me), the Treasurer and Finance Director.

Leadership styles

Much is written about leadership styles and how to adapt them for the task in hand. Ultimately, you are who you are and if you have the attributes of integrity, credibility, accountability, drive, and discipline then you will be able to cope. The one style I do struggle with is charismatic. The ability to persuade by force of personality can be very useful in a crisis but I have seen some bad decisions made when whole committees have been pushed to adopt them against their better judgement. Additionally, leadership for self-promotion will always be seen through!

You need support

Taking on the Presidency or any other key leadership role would be impossible without the support of your colleagues, managers and especially your partner and family. Plan ahead and be honest about what you will need of them and how you will repay them in terms of giving them time and returning the support they gave you so willingly.

Letting go

After an extra year added on to my time to help the Association through COVID-19, I finally left the executive at the BOA Congress in Aberdeen. Five years of being totally immersed in the politics of our profession at a national and international level ended abruptly. My details were removed from e-mail chains and WhatsApp groups, the messages and calls stopped, and my in-box was much closer to controllable. All my experience and knowledge suddenly didn’t seem to matter and to be honest I felt bereft! These emotions were short lived as I realised that you must move on both for yourself and for the outstanding team that are now running the BOA.

I had a wonderful time at the helm, and I will treasure all the memories both good and challenging. I am now an elected Council member of RCSEd and chair the Professional Standards Committee. I have found my usual niche in the quality assurance and provision of examinations for the College. I intend to remain in surgical practice for as long as I am safe and enjoy the job - and to maintain that all important credibility.