Leadership within a multidisciplinary team is inevitably linked to the role and clinical responsibility vested in the psychiatrist. The role of consultant as a team leader depends on whether the team is based in the hospital or the community. The boundaries are amorphous in the community, where nursing staff or other professionals (e.g. occupational therapists) may be the first contact for initial clinical assessments and doctors or psychologists may be the next contact. Team leadership does not necessarily rely on personality or behavioural style but on role and clinical responsibility. Some of this may be due to comprehensive training of psychiatrists in biological, psychological, and social models of illness. Their training in diagnosis and the range of treatments that can be prescribed, their position in service planning, their effectiveness in advocacy, and the degree of contact with patients can all contribute to the possibility of the consultant taking the lead in a multidisciplinary team. In community settings the clinical responsibility for the patient may not be handed over to the multidisciplinary team at all but retained by the original referral agent. In addition to leading the team, the consultant also has to provide clinical and training leadership.
In the United Kingdom and many other countries, the psychiatrist, as a Responsible Medical Officer, is responsible for legal detention of mentally ill patients and also for overseeing their clinical care during admission aand their after-care. This responsibility is clearly associated with the resources required to provide acceptable levels of service. These responsibilities are also related to the maintenance of standards as expected by relevant training bodies such as the professional colleges and registration bodies such as the General Medical Council. In addition, being a member of a consultative body which plans and delivers appropriate services can provide an additional element of responsibility and skill. As a manager, the clinician has to be aware of local employment laws and what is expected of an employer.
Effective clinical managers need the ability to build and motivate a team, set clear and realistic targets for success, and monitor progress. To do this they must be able to relate to people—a skill that good psychiatrists must possess by virtue of their clinical training. The tasks allocated to the team member must be specific, measurable, achievable, realistic, and timed.(3)
In order to perform well, the team will need to develop a sense of responsibility and cohesiveness, where every member is pulling in the same direction. The members must be encouraged to develop a sense of self-worth, achievement, and high morale. To sustain good performance the team members must be presented with even higher goals and standards which must be achievable. Therefore the manager should monitor progress with constructive feedback and be aware of potential pitfalls. The clinician must be conscious of conflict within the team and try to resolve it as soon as possible rather than waiting for the situation to explode. Any conflicts must be resolved effectively and positively. When it is not possible to achieve this, the manager should acknowledge it and remain aware that the conflict remains unresolved.
Individual members of the team should be encouraged to take on tasks on which are within their capability, and a good manager must specify the tasks to be achieved within the limitations of experience, knowledge, and ability. The manager must not allow individuals to be overwhelmed by their tasks, and due public recognition must be given when tasks are satisfactorily completed. Clinical managers obviously need to be aware of current agreements with various professions in relation to clinical practice and also their respective legal responsibilities. An ability to delegate tasks appropriately not only enhances the motivation of others but also allows manager to prioritize their time and concentrate on other matters. Existing team members should be encouraged to retain and develop their skills, and new members must be trained and have a period of induction in order to allow them to understand the functioning of the team.
Managing people involves making decisions based on employment patterns and policies and developing new patterns of management and organizational development. A key problem arises during the management of people in changing situations, especially if the health-care system is being reorganized on a fairly regular basis.
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