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Equipping leaders in health in Malawi: Some personal reflections from a leadership skills-building workshop held at the College of Medicine, Blantyre, Malawi

Maya Jane Bates1, Yohane Gadama2, Jessie Mbamba3, Lucinda Manda-Taylor4,5

1 Department of Family Medicine, School of Public Health and Family Medicine, College of Medicine University of Malawi

2 Queen Elizabeth Centre Hospital, Blantyre, Malawi

3 Mangochi District Hospital, Mangochi, Malawi

4 Centre for Bioethics in Eastern and Southern Africa (CEBESA), College of Medicine, University of Malawi, Blantyre, Malawi

5 Department of Health Systems and Policy, School of Public Health and Family Medicine, College of Medicine, University of Malawi

Corresponding author: Dr. Maya Jane Bates; Email: mjanebates@gmail.com

Published: June 2018 • https://dx.doi.org/10.4314/mmj.v30i2.15

ISSN: 1995-7262


Introduction

Effective leadership is a key component of any health system. The opportunity for multidisciplinary leadership training for health practitioners is relatively new in Malawi. In this paper, we provide an overview of a five-day leadership training course facilitated at the College of Medicine by Professor Rob Moodie, Professor of Public Health at the University of Malawi’s College of Medicine and University of Melbourne.

Using personal reflections written by 4 course participants from diverse backgrounds in health related disciplines, we provide an overview of the design and content of this course, which was intentionally designed to promote multidisciplinary learning. Individually completed reflective questionnaires, exploration of leadership definitions, daily group work (culminating in a presentation on a topical issue) and testimonials from established local leaders were used during the course. From these sessions, we learnt that being intentional in building leadership skills requires both classroom-based learning (to be aware of the skills) and on-going reflection and practice in the workplace. Defining personal leadership values enables continued integrity in shifting and uncertain leadership situations. The experience of giving and receiving feedback in multidisciplinary settings builds leadership potential and our leadership mentors shared that a willingness to take risks brings us closer to achieving our goals. An ongoing cohort of those who have completed this training is being developed.

Improving leadership and governance across the health sector and at all levels is a stated objective of the latest Health Sector Strategic Plan for Malawi1.  The ‘L’ of the ‘LEGS’ framework proposed by Professor Joseph Mfutso-Bengo states that ‘leadership, ethical engagement and governance (LEG) are building blocks to run resilient and responsive systems’2. Most undergraduate medical degree or health-allied programs do not place much emphasis on required core classes in leadership and management skills that aim to introduce and develop leadership competencies and capacities. The mission of the College of Medicine is to be ‘an academic centre of excellence …responsive to the health needs of Malawi and its neighbours in the southern African region.”3 Excellence in training, research and service is a goal that cannot be achieved without leadership which has been described as comprising cognitive, emotional and social competencies4. It is therefore timely that Prof. Moodie. a has brought extensive experience in the design and delivery of leadership training courses tailored for use amongst a global audience of health practitioners4.

In July 2016, 21 people attended this five-day leadership training course.  It was the second training of its kind to take place in Malawi and formed the first cohort at the College of Medicine. The course was structured to foster a collective learning environment that appreciates and builds on everyone’s experiences in a participatory manner. Linking people from diverse health related settings is a deliberate attempt in the design of the courseto promote networking among participants in order to extend their “circles of influence” through the power of shared learning. This is captured in this quote from one of the course participants:

“The beauty and uniqueness of this training is that the learning goes beyond the seminar room… this has been a profound benefit to me – having a group of people in the same health profession willing and eager to help me grow.”

In this article, 4 of us share our personal reflections on leadership from different elements of the course summarized follows:

  • Be intentional in building your leadership skills
  • Define your values as a leader
  • Give and receive feedback for personal leadership development
  • Take risks to achieve your goals

Be intentional in building your leadership skills (Jane Bates, Palliative Care Consultant)

On the first day of the course, participants completed a self-assessment tool which covers 22 leadership skills over 6 domains.  Headings from this are familiar from several leadership books, but the opportunity for self-assessment on a scale of 1-5 forced us to make a measurable baseline assessment of individual strengths and weaknesses. This exercise enabled participants to recognize and acknowledge their strengths and how they can build on these assets, as well as revealing their weaknesses to improve on them. Low scoring priority areas were then clearly summarised, providing clarity of focus for constructing a personal leadership development plan at the end of the course.  Change from clinical to academic work has necessitated a revision of time management strategies to assist with forward planning and goal setting. By sharing ideas with other participants as well as gathering online material, I now have a number of simple tools to help with this.

The course provided the opportunity to review individual strengths and weaknesses as well as a forum to gain new skills and techniques. Being intentional about building skills in leadership takes longer than five days. However, without the course, I would not have gained this renewed positive focus which is helping me in both my personal and professional life.  Taking time out in a supportive environment enables critical self-appraisal with the opportunity to choose priorities for personal growth and development.

Define your values as a leader (Lucinda Manda Taylor, Bioethicist and Social Scientist

One of the first activities we were required to carry out was to describe our understanding, definition and interpretation of leadership. I had applied for the course because I lead a team at home and I lead teams at work.  In both spheres of my life, I am required to engage, discuss and direct. This course was pivotal to my continuous personal and professional development.

At the beginning of the week, I offered this interpretation of leadership, “Leadership encompasses the ability to serve with humility (servant leader) and simultaneously get everyone on board with your mission and vision”. On completion of the course, my understanding of leadership had developed further: “Leadership is not simply about having a position. It is about influencing others positively through inspiration and a passion to achieve desired goals”. Both statements are pretty close to textbook definitions of leadership. However, as I reflected upon my personal leadership style, I realised that I believe there is even more to leadership than this.

When I engage in an internal dialogue with myself that focuses on what leadership is, how I can become a good leader, and who a good leader is, I am confronted with the notion of values. In his book, Rumble in the Jungle: Leadership from an African Perspective, Norman Moyo defines values as “your personal inventory of what you consider most important in life”5.  When I reflect on the core values that guide my leadership style, integrity is the value that resonates strongly.  Integrity means being honest and transparent in the management and leadership of people.  Integrity, honesty and transparency are what many ethicists have defined as “moral capital”.  Values provide a compass for the direction of ethical leadership and can also be employed as part of moral currency to develop a personal ethical framework that can aid in problem-solving and decision making.  Thus, my core value of integrity can aid my daily practice of being a leader.

From the leadership course, my understanding of leadership is that my actions should be driven by internal values. A message that resonated strongly for me was imparted by one of the guest speakers, who talked about “defining your own brand of leadership”.  What was made very clear to me is that each individual brings unique characteristics to their leadership style.  Defining my ‘brand’ or values will enable me to lead from a place of strength and positive choice even when the prevailing situation or group culture might seek to dictate otherwise.  Values-based leadership enables good and ethical choices to be made.

Give and receive feedback for personal leadership development (Yohane Gadama, intern doctor)

A key component of the course was group work. This was carried out each day, with groups working together on a scenario (based on a current real life ‘hot topic’ such as child marriage, non-payment of intern doctors etc.) to produce a presentation which was delivered to fellow participants and facilitators on our final day.  This activity enabled us to get to know our team’s strengths and weaknesses.  This required the individual group members to take heed of Epictetus’ adage, “You were born with two ears and one mouth: we should listen twice as much as we speak”!  Through a process of listening to one another in the first session, we were enabled to tap into the skills of and help others, thereby building a picture of our group’s unique strengths and weaknesses in the process.

I learnt that working together with such a diverse group was a great resource from which to tap practical wisdom on matters of leadership and personal growth.

In addition, the group interactions helped me discover more about myself than I could alone. My weaknesses and strengths were thus brought into focus.  For example one of my group members said of me ‘Most times you are first take a challenge, first to respond to a problem –  you think fast and that’s a strength. But I have noted that sometimes you don’t take enough time to compose your thoughts before speaking. You can do better there – try to listen more than you speak’. This was a very honest feedback from one of my group members during the seminar and it keeps on reminding me of the illustration mentioned above; we have two ears and one mouth, we need to listen more than we speak.

Sometimes we see leadership as an isolated task. However, during the course, I recognised the importance of giving and receiving feedback as part of my leadership journey.

Take risks to achieve your goals (Jessie Mbamba, Family Medicine Registrar)

What do a judge, an investment CEO, an entrepreneur, a researcher and a retired university chancellor have in common? Each day during the course, we had the opportunity to hear from local men and women who have had operated in a variety of leadership positions.  The CEO emphasized the notion of brand-building. The former judge placed value on professionalism. The former vice chancellor and entrepreneur put emphasis on self-belief. I describe the lessons drawn from each speaker below.

The investment CEO emphasized personal branding of oneself as a leader: encouraging us to ‘know your essence, your indispensable quality or value; realising the benefits that you have and the attributes that you bring to a place’. I enjoyed this. The next invited speaker gave us a brief overview of her life, having served in several unique leadership positions; firstly as the first ever female judge, then high court judge and finally as chair of Malawi’s electoral commission.  She shared her approach to these leadership challenges, explaining how she always enjoyed work in which she strived to maintain professionalism: neither avoiding confrontation nor succumbing to societal expectations of submissiveness as a woman.

A former vice chancellor brought his perspectives of leadership from the level of the village to that of founding a major academic institution.  At an institutional level, we were reminded to ‘always remember the objective’, with intelligence gathering being essential before decision making. He also emphasised the importance of self-belief in leadership roles, reminding us of the need to ‘stick to your guns’ in decision making.  This was also by our speaker from the business sector who recounted his story of rising to a leadership position from humble beginnings: “feel good about yourself and the next guy will feel good about you.”

What stood out for me from the speakers was their ability to take risks in order to achieve their set goal. They all related their intention to leave a mark where ever they went, empowering others along the way to be leaders and not simply followers.  Reflecting on this has boosted my self-confidence which will assist me both in my organizational and personal leadership in the future.

Summary and Conclusion

In this paper, we have shared an overview of content and personal reflections from a five-day leadership training course facilitated at the College of Medicine by Professor Rob Moodie. Effective leadership is a key component of any health system.  The opportunity for multidisciplinary leadership training for health practitioners is relatively new in Malawi.  Being intentional in building leadership skills requires both classroom-based learning (to be aware of the skills) and on-going reflection and practice as these skills are worked out in practice.  Defining values enables continued integrity in shifting and uncertain leadership situations.  The experience of giving and receiving feedback in multidisciplinary settings builds leadership potential. A willingness to take risks brings us closer to achieving our goals.

An ongoing cohort of those who have completed this training is being developed.  This group will meet on a regular basis to both learn new skills and provide ongoing accountability as we continue to develop  our leadership development plans. To date, little guidance has been available to develop leadership skills within a multidisciplinary health related context, this course and on-going follow up is a timely and important part of that process.

Conflict of Interest statement

Lucinda Manda-Taylor is the editor-in-chief and Yohane Gadama is an intern of the Malawi Medical Journal but were not involved in the peer-review process of this article, and they did not have any influence on the decision to accept this article for publication. Both other authors declare that they have no competing interests related to this work.

References

  1. health.gov.mw. HSSP II 2017 final; [cited 2018 April 26]. Available from: www.health.gov.mw/index.php/policies-strategies?download=47:hssp-ii-final.
  2. Mfutso-Bengo J, Kalanga N, Mfutso-Bengo EM. Proposing the LEGS framework to complement the WHO building blocks for strengthening health systems: One needs a LEG to run an ethical, resilient system for implementing health rights. Malawi Med J. 2017;29(4):317-21. http://dx.doi.org/10.4314/mmj.v29i4.7

     3.University of Malawi College of Medicine [internet]. Mission statement [cited 2018 April 24]. Available from : https://www.medcol.mw/about-com/

  1. assets.publishing.service.gov.uk. Daire J, Gilson L, Cleary S. Developing leadership and management competencies in low and middle-income country health systems: a review of the literature. Cape Town: Resilient and Responsive Health Systems (RESYST). 2014. [cited 2018 April 26]. Available from https://assets.publishing.service.gov.uk/media/57a089d6ed915d622c000415/WP4_resyst.pdf
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