Wednesday, 22 May 2013

Horizontals & Vertical - healthcare has to get it right

Medical/technical knowledge is vertical. Leadership knowledge is horizontal. Healthcare, especially doctors, need to understand this.

Clinical and medical knowledge i.e. technical knowledge – is vertical. It always starts with wide basic foundations and over time doctors knowledge becomes deeper and narrower. As a first year medical student you need to know about everything about a human body. But, say someone like a anal sphincter repair specialist or a paediatric neuro oncologist, who are very highly defined sub-specialists deliberately move away from their broad knowledge to knowing everything about their narrow scope of work. Such knowledge can mainly be learned from senior, mostly older more experienced persons, who have a higher technical knowledge. The process is pyramidal. Quite rightly so.

Leadership (and many aspects especially non-technical aspects of management) i.e. non-technical knowledge is horizontal. Leadership starts small and expands widely around us mostly in a flat transverse plane with amorphous blobby edges not necessarily circular. Leadership is where anyone and everyone has something to offer/teach/show anyone and everyone else irrespective of age, sex, colour, nationality, hierarchy, wealth, etc. The process is similar to an amoeboid motion expanding and ending up with varying end dimensions, yet no well defined end points for learning and development (though leaders themselves do have goals and aims).

Pilots learn flying (technical) mainly from other older, more experienced pilots – vertical; but crew resource management techniques (non-technical) is learned together with all staff who will be in an aircraft - horizontal.

What may be happening is that we are learning clinical, medical and technical stuff in multi-disciplinary, multi-professional combined learning atmosphere (some of the learning using this approach especially for procedural skills may be valid)


Leadership learning is being offered in situations and by organisations mainly or solely consisting of, designed for and responsible for doctors (such as deaneries, FMLM and many others).

I do not think there should be doctor leaders or nurse leaders which is what we find now; at least within organisations such as the NHS there should be leaders who happen to be doctors and leaders who happen to be nurses. Courses, teaching systems, learning atmospheres, pathways, about leadership in healthcare that are exclusive to any profession does a disservice to the whole cause by pre-defining a narrow mental perspective. The hierarchy in the professions are based on narrowing similarity (vertical) whereas leadership is based on broadening equality (horizontal).

It is possible that healthcare is now confused between horizontals and verticals. The quicker we resolve it the more successful we will be.

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