Leadership in Veterinary Medicine. Clive Elwood

schools, changes to practice ownership structures, sale of practices to consolidating organisations, the influence of ‘big business’ on the practice of veterinary clinical medicine, the retirement of practice owners who have had no incentive to develop their successors, a high dropout rate of veterinary professionals in the early years of their career, a low return‐to‐work rate and increasing reliance on self‐employed professionals with portfolio careers have all lead to a leadership crisis and, in clinical practice at least, a vacuum at the top and middle layers of practices. This in turn has, I believe, contributed to the vicious cycle whereby an absence of effective leadership and support has contributed to burn‐out, lack of confidence, motivation and ambition, and cynicism regarding leadership itself.

Recent years have shown a changing relationship with leaders and leadership in our wider societies too. In the 1990s and early 2000s there have been recurrent failures of top business and political leaders, regular economic, moral, and political scandals, financial failures on a global scale and an inability to face world‐threatening issues such as climate change. Alongside this, the massive changes in social structures, networks, and communication systems have made it much more challenging to control the message (although some have tried, and managed, depressingly effectively) and allowed some bad leadership to be exposed. Unfortunately, this has also undermined the importance of, and benefit from, good‐enough leadership, which is often forgotten, overlooked, or taken for granted.

Table 2.1 Eight possible archetypes of veterinary professionalism and their associated personal narratives.

      Source: Adapted from Hafferty and Castellani (2010).

Professional Archetype	Narrative
Nostalgic	I exemplify the profession ‘as it used to be’. I set high standards of competence and will always go the extra distance for clients and patients.
Entrepreneurial	I am proud of delivering competent work and comfortable charging the client for good work, well done. Business growth is good for all.
Academic	I am driven by curiosity, motivated by the freedom to explore better ways of practicing and I enjoy sharing ideas and knowledge.
Lifestyle	I won't subsume my personal life for my professional life. I am willing to work hard but expect boundaries to be defined and maintained. I expect fair reward.
Empirical	I will use my knowledge and the evidence to deliver the best professional work I can in the service of their patients.
Unreflective	It works for me, and for my patients, so why do I need to change? And my clients think I am great.
Activist	The world is broken, and I need to fix it. I serve the greater good. I don't care about money or personal rewards.
Relational	The world is complex and ‘wicked’. I co‐create solutions with other stakeholders to promote good outcomes for my patients and custodians.

2.9 Veterinary Teams

Veterinary professionals rarely work in isolation. In most arenas, they are working with colleagues, veterinary and non‐veterinary, without whom they could not exercise their obligations. These teams may have many different shapes and sizes, ranging from the small practice with two or three veterinary surgeons, some veterinary nurses and administration staff to the farm animal practitioner who is no longer the ‘cow doctor’ of old but is now a data scientist working in a team with farmers, animal health advisers and technicians. Or from the specialist surgeon in referral practice working in a multidisciplinary team with anaesthetists, specialist nurses, diagnostic imagers, medicine specialists, the client and the primary care veterinary surgeon, etc. to the technical adviser in a pharmaceutical company working with marketing, sales, vets in practice and research scientists. In all of these scenarios effective teamwork and leadership can make a difference to team members and the wider stakeholders and, within this, the veterinary professional has to take responsibility for, and negotiate, their professional obligations and the primacy of animal welfare, whether or not they are not the only person in a leadership role. Within the constraints of professional obligation and depending on the task in hand, it may be entirely appropriate that a someone other than a veterinary professional takes leadership responsibility.

      The farmhouse kitchen was an unconventional space for a high‐stakes team meeting, but it was a rare opportunity to get together face to face and discuss the farm's productivity and how to best manage some of the challenging issues. Frank looked around the room and was pleased to see everyone was ready; Jane the farm manager, Peter the nutritional consultant, Jo the herdsman, Sue the AI technician (and Bess the obligatory border collie under the table). ‘Right’, he said, taking a last bite of cake and mouthful of tea (some parts of farm practice remain as good as ever), ‘Let's get started’.

      The concept of veterinary teams has gained formal prominence in recent years as the profession adapts to rapid changes in the economic, social, and regulatory landscape. These include:

       An expansion in the range of allied professionals and members of the team operating within this environment

       A change in the expectations of pet owners, farmers, industry, government, and other clients

       Concerns about the capacity of the veterinary workforce (British Veterinary Association 2019)

       Increasing team size and leverage of veterinary professional skills in clinical practice, through use of suitably qualified, trained, and skilled non‐veterinary staff as a result of business remodelling

      Within this context it is notable that, in the 2019 RCVS Survey of the professions, respondents did not have a high opinion of the profession's development of leadership skills, with over half (52%) disagreeing or strongly disagreeing that the profession pays sufficient attention to this area of professional practice (Robinson et al. 2019a).

2.10 What Difference Does Leadership Make?

      How do we know leadership makes a performance difference? Intuitively, of course, we know there is a difference between good leadership and bad, and that leadership matters (Hogan et al. 1994). Assessment of whether or not leadership is effective will depend on criteria you are assessing; excellent financial performance might be seen but at the expense, for example, of a significant negative impact elsewhere (Hiller et al. 2011).

      The importance of leadership in the medical professions, from which we can extrapolate, is summed up as follows:

      Leadership is the most influential factor in shaping organisational culture, so ensuring the necessary leadership behaviours, strategies, and qualities are developed is fundamental. There is clear evidence of the link between leadership and a range of important outcomes within health services, including patient satisfaction, patient mortality, organisational financial performance, staff well‐being, engagement, turnover and absenteeism, and overall quality of care (West et al. 2015).

      When defining and defending the significance of ‘good enough’ leadership I find it helpful to turn the question around and look at the impact of bad leadership. The lessons of patient safety failings in human medicine, e.g. the Mid‐Staffordshire NHS Foundation Trust scandal in the UK, where horrifying failings of patient care have been documented, e.g. in obstetric services, and the contributions of bad leadership to real human suffering, should be more than sufficient evidence that leadership matters (Francis 2013). Even on a much smaller scale, in veterinary medicine,