Lessons from the London Darzi fellowship

The prestigious Darzi Fellowship has now passed its 10th birthday. During that time many Darzi Fellows have experienced a unique combination of learning, development, innovation and leadership. There is an ever growing alumni of Darzi Fellows, these Fellows are a new generation of healthcare professionals, who have a clinical role or background coupled with the skills of systems leadership, and innovation.

The Darzi Fellowship is a case study in best practice for clinical leadership development. The evaluation of the London Darzi Fellowship programme carried out by Stoll et al., (2010) describes the value of the fundamental relationship between workplace and programme learning, described in the following diagram:

Eval Darzi

The report by Stoll and colleagues attributes the success of the programme (which at this stage was for doctors only) to:

  • Committed and learning oriented MD
  • Supportive Trust culture
  • Working on ‘ambitious but appropriate’ live projects
  • High quality mentoring
  • Learning programme that targets transformational change
  • Combining workplace and external learning
  • Network of support – from formal to informal social learning

As the Fellowship developed into a clinical leadership programme, and the context in which the Fellowship operated change, the design of the fellowship was iterated, and the impact remained. Conn et al., (2015) in their survey of Darzi Fellows found 94% of their 90% survey return rate reported the programme as worthwhile. 85% felt more empowered to improve health care systems, particularly through developing collaborative clinical networks.

Overall a Longtitudinal study of the Darzi fellowship (Mervyn & Malby 2017) demonstrates its effectiveness in securing clinical leadership who can contribute too and lead the Triple Aim – ensuring high quality healthcare, securing overall community health and managing costs. The study showed that:

  • Fellows are emerging as leaders, acting as catalysts for sustainable change in the healthcare environment
  • The Darzi programme continues to be successful with learning and behavioural change sustained after the Fellowship year

Malby et al (2018) found that in a review of the Darzi Fellowship “Several concurrent processes must happen for clinical LD programmes to be genuinely impactful. Leadership students must collaborate as a group or team. Innovation, the basis of systems change, is the result of a team effort. These clinical teams should be diverse, especially multidisciplinary with a level of healthy conflict, and the students must be reflective and resilient. “

The Darzi Fellowship Programme at LSBU is designed based on the principles proposed by Edmonstone (above) along with those of Swanwick and McKimm (2014) who summarize a set of principles for design of leadership development namely that they should be:

  • Practical: through the incorporation of the development of key skills such as coaching, change management, and negotiation
  • Work oriented: by including project work as a key component supported by action learning sets
  • Supportive of individual development: through 360° feedback, coaching, and mentoring
  • Link theory to practice: through the provision of selected leadership and management literature, relevant to the educational context
  • Build networks: through action learning, coaching, and social networking.

The Current Fellowship

The Darzi Fellowship supports early career clinical leaders, who take a year out from clinical training/ practice to develop their skills and capabilities in leading complex change. Fellows work on an intractable complex problem (the Fellowship Challenge) within an NHS organisation, where previous attempts to make an improvement haven’t made the difference expected; or an emerging complex problem where it’s not clear what to do. Host organisations provide an innovation space for the Fellows to test out new approaches to complex (wicked) local issues, in order to make a real difference to the quality of local health services.

The Fellowship work includes:

  • Inquiry
  • Developing a culture of change
  • Discrete projects across a system
  • Building collaborative relationships
  • Connecting theory to practice, and a better use of data in the system
  • Systems leadership

The PGCertLeadership in Health (Darzi)  takes Fellows through a journey of foundations of change, learning all the approaches needed to undertake a complex change, from scoping through to implementation and evaluation. Development of understanding of methodologies for change, personal strategies and skills for leadership including working with peers and with diversity are embedded in the programme workshops. These are applied and reviewed in Action Learning Sets and through the coaching and co-consulting sessions with Faculty where Fellows seek advice and support for the design and implementation of their change work.

A major strand throughout the programme is developing the ability to work effectively and productively with peers from diverse backgrounds (including service users). Throughout the programme the Fellows are exposed not only to the theory of clinical leadership but also to experienced clinical leaders, who share their personal approach. This also provides a network for the Fellows for current and future mentoring.

A  critical part of the Fellowship is learning about how to coproduce change with citizens as peers – here are colleagues from the LSBU Peoples Academy who join the programme.

ROO_0384

The programme is congruent with the principles for effective leadership development identified in the last blog and re-listed here below:

Effective Leadership Development Principles and Practices

Overall the evidence suggests that any Clinical Leadership Programme needs to include the following:

  1. Adult learning methods in understanding distributed leadership, systems and how they work, power, approaches to quality, change management, collaborative decision-making. This means an inclusive, collaborative approach to learning events (workshops) with little didactic learning.
  2. Skills development in working with diversity and conflict, negotiation, personal resilience, change practices for wicked and tame problems, inquiry, critical analysis, reflection, learning to live with uncertainty, and working with people and communities as assets.
  3. Organisational application – a real piece of leadership change work where the clinical leader can practice their new knowledge and skills, and learn through doing and reflection, and peer review with colleagues in an action-learning approach.
  4. Clear mentorship of the clinical leader in their own organisation as they learn to apply their new learning in practice, providing air cover for the clinical leader to experiment with new skills and practices.
  5. Leading as peers – using the clinical leadership learning group as the case material for understanding how to work as clinical peers in a distributed leadership model.
  6. Personal Leadership application – knowledge development supported in its application by coaching.
  7. System mentorship to support ongoing careers and sustainability of the programme learning.
  8. Opportunities to build networks for personal development and support beyond the programme, and in support of the organizational change effort they are leading.

The Darzi Fellowship will shortly open for applications at LSBU for September 2019. Please contact me if you would like to host a Fellow.

References

Conn, R., Bali, A. & Akers, E. (2015) Taking time out of training to shed light on “the dark side’ BMJ 351:h5231

Malby, R., Mervyn, K., Boyle, T (2018) Darzi Clinical Leadership Fellows: an activity theory perspective. Journal of Health Organization and Management. Vol. 32 Issue: 6, pp.793-808

Mervyn K, and Malby, B (2018) Longitudinal Study of the Impact of the London Darzi Fellowship Programmes. Years 1 – 8. London South Bank University.

Stoll L, Foster-TurnerJ, Glenn M. (2010). Mind Shift. An evaluation of the London Darzi Fellowships in Clinical Leadership. London Deanery and IOE London

Swanwick T, McKimm J. (2014) Faculty development for leadership and management. In: Steinert Y, editor. Faculty Development for the Health Professions. New York, NY: Springer.

 

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