As professionals, we want to see patients receiving the highest possible standard of healthcare. In the current environment of rapidly developing knowledge and technology that means, as a minimum, maintaining and improving our skills to ensure the management we offer is the most effective and up to date. In addition, as Christians, we should be offering an extra dimension of care arising from our own experience of God's love to us in Christ. However, this ideal is challenged on a daily basis as we face the pressures of working in the complex bureaucracy that is the modern National Health Service. Sometimes it seems that maintaining the system has become an end in itself. This perception is strengthened by targets which seem to relate more to what can be easily measured than to what really impacts on clinical outcome.
A common response to perceived shortcomings in our workplaces is grumbling. We complain about the problems that we face and (often) recall fondly how much better things were in the past (they weren't; I was there). A more constructive approach is to draw the attention of management to specific problems with solutions or suggestions for improvement. A third option, which I believe each one of us should prayerfully consider, is to become involved with management and leadership within the organisation where we work whether this be serving on committees in the CCG or NHS Trust, acting as Clinical Lead for a particular service or even becoming Medical Director within the organisation. There are, of course, parallel leadership roles that may better suit our gifts or temperament, for example roles within the Royal Colleges or academic roles within medical schools. The important question is 'Where is God calling me to serve?'
Should Christians be involved?
Most health professionals are reluctant to become involved in management. After all, most of us entered our profession with the idea of caring for patients. One challenge is the time commitment of being involved in management. Inevitably, the more we become involved in management the less time we will be able to devote to clinical practice. It may also mean that we have to cut back on churchrelated activities, which can result in a negative impact on how we are perceived by our fellow Christians. Sadly, even as Christians we have bought into the modern separation of sacred and secular, so that we see what we do at church as our 'work for God' and what we do in the clinic as (at best) our 'work for humanity' or (at worst) our 'work for the NHS'.
The Bible is clear that God is sovereign over all areas of human activity. God created humans to manage and control the earth. Despite the Fall, God still chooses to work through humans and the authorities that exist are appointed by him. The Bible is explicit on this subject: remember both Peter (1) and Paul (2) recognised the legitimacy of the Roman authorities even though they were distinctly anti-Christian. Those involved in leadership at any level are doing God's work whether they recognise it or not. This also means that involvement in leadership and management is a legitimate form of Christian service. In support of this, we have the example of Joseph3 and Daniel, (4) both of whom served at the highest level in pagan governments having been very clearly called to this role by God.
Is God calling you to leadership?
The first stage in answering this question, I suggest, is to examine your gifts. As a general principle, it is a good idea to explore your gifts with someone who knows you well. Not everyone is called or equipped to take a formal leadership or management role, but Paul recognises a gift of leadership. (5) If you have such a gift then it could be that the NHS is the context in which you should exercise it. Secondly, look out for opportunities to use your gift. Whatever your role in the health service there are likely to be opportunities to contribute to management tasks. These tasks are not always popular with our colleagues. Prayerfully consider whether you should volunteer. A willing volunteer will be welcomed with open arms. Again, talk it over with a trusted friend. Start small, get experience and who knows where it will eventually lead. I am always encouraged by the enthusiasm and insight of the student representatives I meet on various committees. I am even more encouraged when I meet them at later stages in their career and find them still engaged in leadership activities.
How should leaders behave?
It is important to remember that the reason for becoming involved in leadership is not for selfaggrandisement or to improve your CV. Paul reminds us that we are to do nothing out of selfish ambition or vain conceit; that we are to value others above ourselves; and to look to the interests of others. (6) Our example in this is to be Jesus himself.
In practical terms, an important part of our task will be to keep the focus on the care of patients as the reason for the existence of the health service. This will not exempt us from difficult fiscal decisions in times of constrained resources but should encourage us to look for creative solutions. In my own practice, introducing a 'one stop clinic' for patients with suspected breast cancer improved the service to the patients and saved the Trust money by reducing the number of outpatient appointments needed before a diagnosis and decision on management was reached. Maintaining the status quo is not necessarily a Christian virtue; providing caring service is. The second great commandment is still 'You shall love your neighbour as yourself'.
The love of neighbour extends to our colleagues of all grades and roles. If a cup of cold water given in Jesus' name will receive a reward, what is the outcome of a cup of coffee and a friendly word for a junior colleague who is at breaking point? The medical profession has not been good at supporting members of the profession who become stressed for whatever reason whether it is the emotional trauma of ill patients, the effects of overwork or the impact of personal life events. Providing support to members of the team is a fundamental part of being a good leader. Christians should provide outstanding examples of how this can be done. Am I the sort of person to whom somebody in need of help would naturally turn?
How should leaders challenge injustice?
An uncomfortable part of leadership is challenging poor performance or bad behaviour. Again this is an area where the medical profession has often failed. The Kennedy Report provided evidence of systematic failure in this regard in reference to cardiac surgery in Bristol. (7) Depressingly, similar issues were found 20 years later by the Francis Report into the Mid Staffs Trust. (8) This may be due to a fear of confrontation or to a misplaced sense of loyalty, but the patients involved have experienced a particularly unacceptable form of injustice. God is deeply concerned that justice should prevail (9) and as his people we should not be afraid to speak out against anything that will lead to injustice for our patients or our colleagues. Speaking the truth in love may be difficult and there is a danger of becoming strident, but Jesus promised that when we needed to speak to the rulers and authorities we would be given the words to say. (10)
So, is involvement with leadership worth the hassle? Certainly. So then, if God is calling you to it – what choice do you have?
Sam Leinster is the President of CMF and Emeritus Professor of Medical Education at the University of East Anglia.
