Joint clinical academic roles: sharing learning

Do you feel a “a serious lack of organisational and professional value” placed on NMAHP clinical academic skills, knowledge and, ultimately, roles that you try to advance?

I have spent most of my NHS time from 2014 to 2019 trying to influence NHS and HEI systems and people in order to advance, develop, shape (pick a verb…) meaningful post-PhD clinical academic roles. Roles that would involve a person’s meaningful engagement in both the NHS and academia. Roles where the person in the middle of it would feel they are welcome and valued on ‘both sides’ and able to contribute effectively to both clinical and academic activities.

It’s more than fair to say that most things I and colleagues tried in this regard had from very little to no effect. Little traction beyond some very generic positive noises and nods. In fact, in some roles we went back wards – some people became less able to work across organisations.

However, we did also manage to achieve some small progresses, from which I gained learning that might be worth sharing.

The following is not a narrative of what we did, but a summary of my personal key learning points. It’s based as much what failed as well as what I did ultimately see making a difference. I am sharing these in a spirit of shared learning, not to claim credit or expertise. Some seem self-evident, but perhaps still worth articulating.

Agree a clinical population priority area. We resisted identifying clinical priority area(s) for years, largely for a fear of alianating all the other areas in a situation where we were thin on colleagues to start with. But ultimately a meaningful clinical academic leadership role needs to be embedded within a clinically meaningful context. I now think it’s worth accepting this early, and seeking to nail down an acceptable priority area for both the NHS and HEI organisation. This focuses discussions and makes it easier for both organisations to make a firmer decision about whether or not they will be involved.

Secure firm sign off from senior leaders in both organisations. From my experience, I now think that to progress meaningful, organisationally valued roles requires a firm sign off from the very senior levels (think of Dean in HEI, Director of Nursing in NHS). This is because at some point during the subsequent implementation there’ll be such major challenges that sustaining the course needs the very senior level leaders to progress.

In this context, by firm sign off I mean presenting the very senior leadership a specific, written proposal for the plan, and not progressing before they have explicitly approved it without any further changes. This may be an internal proposal, but perhaps gaines more focus as an external submission, e.g. to a small pot of funding to underpin the work.

Bring the key opinion leaders on board. This is likely to involve quite a lot of people in various roles. It’s the clinical academic colleagues in the priority clinical area but also beyond (it usually needs a community to grow a clinical academic role!). It’s the various managers and medical leaders. And it’s also the key administrative people in HR, finance, and beyond. This task, in my experience, is a lot messier than the senior sign off, and usually involves a lot of listening of the different people’s priorities and allowing them to have a genuinely powerful role in planning how the role will work out on the ground. It will likely involve pitching (and at times pushing) for the clinical academic role. For success of this, the earlier senior sign-off is key. And, if it was me, I would probably expect this task to be on-going and evolving rather than something I can ever tick off as “done”….

Invite interest in the role through a broad call – whether an open EoI or advert. For some this is a no brainer, but equally as many will know how emerging opportunities just seem to go to certain people without much discussion. Taking all the important HR and equity reasons as given, there is a further powerful reason for doing an open call (whether an informal expression of interest or a formal advert). That is, it provides an invaluable starting point for the subsequent ‘capacity building network’ of interested (aspiring) clinical academics in the priority area. It’s a way to engage the wider community that will ultimately make the role a success.

Establish the foundations for an effective feedback loop. Clinical academics can often be the worst enemies of their missions (yes, I put my hand up!). We get excitedly involved in many things. We don’t capture evidence about all our achievements. And we don’t report our progress upwards and side ways to make sure our impact becomes noticed. But we need to do this for the organisation to feel the role does indeed provide value. To help this, in developing a role we can put infrastructure (e.g. specific KPIs with dates and lines of reporting) in place that facilitates on-going evaluation and opportunities for feeding back information about the value of the role. That helps to sustain and grow the role further; and can also be incredibly empowering for the person in the middle (anyone who is allergic to idea of goals please see the substantial of evidence on the positive effects of meaningful goals on our self-efficacy, sense of purpose and motivation, and clarity of role).

That’s my main points, I think… I realise the above has not gone into much detail, and that is deliberate. There are many ways to achieve the above end points, some better and some worse – all likely context dependent.

One final note. You’ll maybe notice I have not included “write the job description” above. And that is deliberate. Job descriptions have a place in developing clinical academic roles, and I have seen where that route works. But so often I have also seen that route not working, and the years we have spent feeling we cannot progress these roles for a lack of an example JD to take to HR… I’m now a lot more pragmatic: don’t let a lack of a job description to prevent an emergence of an otherwise meaningful, joint clinical academic role.

My final learning point and realisation is a more personal one. Many of us already feel, from one source or another, a lack of value placed on our skills, our knowledge and our roles. So let’s not, for heavens sake, add to that by stabbing one another. If one of us leads something it’s all the better for all of us. Let’s get behind one another, and let’s share leadership; there is plenty of patch to cover.

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