Military healthcare strategy and leadership
Robin Cordell is involved in medical strategy and policy at the UK’s Ministry of Defence, and supports medical students and trainees in leadership and management
Robin Cordell is head of medical strategy and policy at Headquarters Surgeon General, Defence Medical Services UK. He develops strategy for the Defence Medical Services, which provides healthcare to 196 000 servicemen and women to ensure they are medically fit for duty. He trained as a GP, then an occupational physician, and now works in a full time management capacity. He supports medical students and trainees through his work with the faculty of medical leadership and management.
What stimulated your interest in leadership?
I suppose I have always been interested in leadership, even at school. We were encouraged to feel part of a wider family with shared values, as well as to take part in community service and other activities that promoted initiative and teamwork. I think this laid a good foundation for developing leadership skills during my career.
How did you develop your own leadership skills?
I had spent a gap year in the infantry just before medical school, mainly in Belize, as a junior officer. Two things became clear to me at this time—firstly, delivering results in most walks of life is about teamwork, and that your role as the leader of a team has to be earned. Secondly, the army builds and maintains its culture and ethos by emphasising the importance of the team, and treating all its members as a family—again, this is all about shared values.
Leadership can be developed in several ways at undergraduate level, whether consciously or not. In my case, I ran my university’s RAG (raising and giving) week and later became the Students’ Union president, which exposed me to curriculum development and other issues. I also continued my military interest through the Territorial Army, running an infantry platoon in my first couple of years at university.
I then had little involvement with the military until after GP training and five years as a partner. As GP practices are independent businesses, there is a definite need for leadership and management skills in this setting. We had some exposure to this during our training, but I did draw on my military experience in contributing to the management of the practice. Management training for GPs has developed considerably since then, rightly so given its importance in day to day practice, and also at the more strategic level in light of the changing NHS.
How have military clinicians been able to influence decisions about healthcare?
Most of the important improvements that we have seen in the clinical care of casualties on operations have been brought about by improvements in clinical practice initiated and implemented by clinicians. This has been achieved through influence, and publishing the evidence of the efficacy of these improvements. Therefore, my view is that whereas experience of direct leadership (or command) roles is of value in preparing clinicians for leadership, what makes more of a difference to patient care is the development of influencing skills. This, of course, comes with practice, but can be developed through coaching and mentoring, and is where I would suggest those who are interested in developing “medical” leadership—for example, through the faculty of medical leadership and management—should focus their efforts.
What is your experience of strategic healthcare?
I was the lead for medical support in south Afghanistan, although my focus was at the operational rather than strategic level. I coordinated the efforts of combat operations with aviation and medical staff to prevent illness, evacuate the seriously wounded from the field, provide treatment in four field hospitals, and evacuate the wounded out of the country. I was also engaged with the development of Afghanistan’s health sector. I then became the allied command operations medical adviser, where I was involved at the strategic level co-coordinating support to all NATO (North Atlantic Treaty organization) operations, including the mission in Afghanistan, but also for counter piracy operations and the Libya intervention.
What are the benefits (and perhaps hindrances) that military management styles and strategies bring to medicine?
The public perception of the military style (just giving orders) might have a role in extreme situations but this is not the day to day reality. Giving detailed orders and imposing unnecessary control hampers initiative and is likely to lead to failure—success in military operations depends on an understanding of the intent of the next level up in the organisation (and indeed the broader aim of the undertaking.) This “effects based” approach is called Mission Command and it has clear lessons for medicine. The Francis report speaks of the focus in Mid-Staffordshire being on targets rather than on the quality of patient care, which is at variance from the purpose and ethos of the NHS.
I believe that it is the real military leadership style—a constant concern for the welfare of those under your command, and the use of teamwork to achieve a common goal in an ethically acceptable way—that has a definite “read across” to medicine and the delivery of healthcare in all settings.Adebowale Oyegoke, fourth year medical student1, Ben Williamson, fifth year medical student1
1King’s College London
Competing interests: None declared.
The views expressed here are those of the person interviewed and should not be taken to represent the views of the Ministry of Defence.
Provenance and peer review: Not commissioned; not externally peer reviewed.
Cite this as: Student BMJ 2013;21:f5798