Posts Tagged ‘Leadership’

Doctors must not sign up to ‘gagging clauses’

By Mike Broad - 26th January 2012 10:03 am

Doctors cannot enter into contracts or agreements with ‘gagging clauses’ and have a duty to act when they believe patient safety is at risk, new GMC guidance stipulates.

The new guidance Raising and acting on concerns about patient safety seeks to increase doctors’ sense of responsibility for the care they witness and to encourage ‘whistleblowing’.

The guidance explains when doctors need to raise concerns if patient safety is at risk, or when a patient’s care or dignity is being compromised, and advises on the help and support available to them, including how to tackle any barriers that they may face.

Niall Dickson, chief executive of the GMC, said: “These clauses are totally unacceptable. Doctors who sign such contracts are breaking their professional obligations and are putting patients, and their careers, at risk.”

Doctors also have responsibility for the safety and wellbeing of patients when performing non-clinical duties - including when they are working as a manager. New guidance Leadership and management for all doctors has also been issued with the aim of helping doctors understand their responsibilities in relation to employment issues, teaching and training, as well as planning and using and managing resources.

Responding to the guidance, defence body MPS said employers had to do more to support doctors in raising concerns and remove “the barriers”.

Dr Stephanie Bown, director of policy and communications at MPS, said: “We receive calls from members who have seen things that cause them concern, and who are seeking clarification about what to do. Unfortunately many express fear about the potential consequences of ‘rocking the boat’ and that they might be penalised for speaking up.

“The readiness of doctors to fulfil this professional responsibility has been clouded by fear of the potential consequences. It’s unacceptable for organisations and clinical leaders to simply pay lip service to ‘raising concerns’ about patient safety - they have to live it and they have to lead by example.”

The GMC’s new local liaison service will use the guidance and work with medical directors, doctors and patients groups to help foster openness and a willingness to speak out.

Dickson said: “Being a good doctor involves more than simply being a good clinician. It means being committed to improving the quality of services and being willing to speak up when things are not right - that is not always easy but it is at the heart of medical professionalism.

“Our new guidance also makes clear that doctors must not sign contracts that attempt to prevent them from raising concerns with professional regulators such as the GMC and systems regulators, such as the CQC. Nor must doctors in management roles promote such contracts or encourage other doctors to sign them. Those who promote or sign such agreements are breaking their professional obligations and putting their careers at risk.”

The guidance comes into effect on 12 March 2012.

MPS’s Brown added: “It is not about an organisation having a ‘policy folder’ that they dust off when there is an issue, it’s about the organisation developing the type of working environment which encourages and supports their staff to raise concerns openly, following the appropriate procedure.”

Read the raising concerns guidance and leadership guidance.

Tags: , ,
Posted in Hospital Dr News | 1 Comment »

“NHS is under-managed but over-administered”

By Mike Broad - 23rd May 2011 11:26 am

The NHS is under-managed but over-administered, a report from the King’s Fund finds.

It calls for a new style of leadership to overcome unprecedented financial pressures and adapt to future challenges.

High-quality, stable management is key to high-performing health services, it finds. Yet across the NHS, the average chief executive spends just 700 days in post. In part, this reflects a culture where ‘heroic’ leaders grapple with problems only from the top of the organisation, or are ‘parachuted in’ to replace individual managers and ‘turn around’ troubled NHS services. The report advocates a new type of ‘shared leadership’ involving leaders at different levels of the workforce working collaboratively with all those involved in patient care to lead change and improve services, rather than only tackling problems inside specific institutions.

The report criticises the government for not assessing the future needs of the NHS before imposing a 45% cut in NHS management posts and 33% cut in administration costs.

It says: “There is no persuasive evidence that the NHS is over-managed, and a good deal of evidence that it may be under-managed. While administration and management costs will have to take at least their fair share of the pain as real-terms growth in NHS spending ceases, a more sophisticated approach to the reduction in both is needed.”

It explains that a large cohort of NHS administrators has developed over time to respond to extensive and often duplicated requirements from multiple regulators and performance managers; an urgent assessment of the information demands placed on the NHS is needed.

It urges each NHS organisation to take responsibility for its own leadership development and quality of management, including dealing with failing managers.

The report also recommends that the work started to strengthen leadership and leadership development should be taken forward through the creation of an NHS Leadership Centre.

Prof Chris Ham, chief executive of the King’s Fund, said: “We know there is public support for reducing the number of NHS managers. But given the immense challenges facing the NHS, politicians of all parties must resist the temptation to denigrate the value of management in delivering excellent and efficient services.

“The priority for the future NHS must be to deliver the best care possible to those with chronic and long-term conditions. That needs a new style of NHS leader, as adept at building partnerships to deliver care across boundaries as they are at managing their own services.”

The NHS officially has around 45,000 managers although this figure is not definitive, with many clinical managers excluded from the figures.

A survey of 2,000 people in July 2010 by the Local Government Association found that the public’s top choice for spending cuts was NHS managers (69% approval).

However, a review in 2009 showed that NHS organisations were subject to 35 different regulators, auditors, inspectorates and accreditation agencies requiring information from different parts of the system.

Report recommendations include:

1. Promote the value of good NHS managers and leaders. Denigration of managers and the role they play in delivering high-quality health care will be damaging to the NHS and to patient care in the short and long term.

2. A review leading to a rationalisation of the demands of regulators.

3. Leadership development needs to extend ‘from the board to the ward’. One of the biggest weaknesses of the NHS has been its failure to engage clinicians - particularly, but not only doctors - in a sustained way in management and leadership. Management and leadership needs to be shared between managers and clinicians and equally valued by both.

4. Board development and recruitment need particular attention, most notably, but far from exclusively, in the case of foundation trusts where governors are to take on a new role as the autonomy of foundation trusts is significantly enhanced.

5. The same applies to the governance arrangements for the new commissioning bodies.

6. More effective mechanisms to debar individuals who have clearly contributed to poor standards from holding executive positions in healthcare. The report, however, has reservations about professional accreditation of managers or the creation of a full-blown disciplinary body for them. Boards must ensure that they have competent, effective senior managers and leaders and hold them to account. A national NHS leadership centre should consider whether the effectiveness of senior management and leadership should be considered by the Care Quality Commission as an important determinant of organisational performance and be taken into account in processes for registering and licensing health care providers.

Read the full report.

Tags: ,
Posted in Features | No Comments »

One in three afraid to report poor colleagues

By Mike Broad - 7th March 2011 11:31 pm

Doctors are still fearful of reporting underperforming colleagues, research reveals.

The study shows that almost one in five UK doctors has direct experience of an incompetent or poorly performing colleague in the past three years.

Nearly three out of four of these doctors said they had sounded the alarm, but one in three of those who had not done so gave fear of retribution as the reason.

The study authors canvassed the views of almost 2,000 US doctors working in primary care and hospital medicine, and over 1,000 of their UK peers, in 2009 about various aspects of professional behaviour.

Topics included quality and safety issues, conflicts of interest and attitudes to patients.

One in four doctors in the UK admitted they hadn’t sounded the alarm about the poor performance of a colleague because they thought someone else was taking care of the problem.

When it came to the quality of their own performance, twice as many US doctors agreed that periodic recertification was necessary. But only just over half of US doctors agreed with this, despite recertification having been in place for several years in the US. Revalidation for UK doctors is due to start in 2012.

Other findings in the study, published online in BMJ Quality and Safety, include only eight out of ten respondents in both countries strongly agreeing that patient welfare should come before their own financial interests; only six out of ten saying they should disclose any financial relationships they had with pharma companies to their patients; and, not all agreeing that it was “never appropriate” to have a sexual relationship with a patient.

UK doctors were also less likely than their US peers to completely agree that all the pros and cons of a procedure should be fully explained to a patient, but when things went wrong, UK doctors were more likely to agree that significant medical errors should be disclosed.

The authors concluded: “We believe that as well as promoting high standards of behaviour from within their own professional societies, it is important for doctors to advocate for healthcare system reforms that facilitate high standards of behaviour. Medical leadership in the UK has been described as conspicuous by its absence and a recent report calls on doctors to assume more active roles in defining the future characteristics of their profession.

“Especially at times of major healthcare reform, as both the USA and UK currently face, doctors have an important responsibility to develop their healthcare systems in ways which will support good professional behaviour.”

There was some evidence that doctors in both countries paid lip service to equality issues. The overwhelming majority of respondents agreed that they should strive to minimise disparities in care due to race, gender, or religion. But fewer than one fifth of doctors in either country had actually looked at data on health inequalities in their practice.

Niall Dickson, chief executive of the GMC, commented: “Doctors have a clear duty to put patients’ interests first and act to protect them; this includes raising concerns about colleagues when necessary. Our consultation on Good Medical Practice asks what more needs to be done to make sure doctors speak up about anything that puts patients at risk.

“The 2009 survey also found that twice as many US doctors supported the need for revalidation or recertification than their UK counterparts, although UK doctors were much more supportive generally of activities designed to improve the quality of care. This may be because doctors are more likely to see the need for something they are already doing. The authors make the point that doctors in the US are more familiar with recertification, which has already been introduced on a mostly voluntary basis in some specialities, whereas doctors in the UK are more used to programmes of quality improvement that have been rolled out across the NHS over the last 10 years. As we approach the launch of revalidation in late 2012, we will continue to work with our partners to ensure that revalidation makes a contribution to the delivery of high quality healthcare in the UK.”

Read the full study.

Tags: , ,
Posted in Hospital Dr News | 1 Comment »

Doctors as managers: a guide to developing the right skills

By Dr Mike Roddis, director of Healthcare Performance - 15th February 2011 1:45 pm

The MDU has developed new guidance for doctors embarking on their first consultant post. In the fifth of a series of articles guiding doctors through the more common non-clinical challenges they might face, we look at the skills needed to successfully manage other members of staff.

As a consultant, you are likely to spend an increasing proportion of your time supervising other members of the healthcare team so it’s worth consider the skills you need to become an effective manager.

Delegation

Many people would accept that good managers delegate effectively, so this is an essential skill to develop, despite any temptation to avoid it by doing the work yourself.

However, effective delegation can, for some, be the hardest management skill to attain. It is not just a case of instructing junior staff to do the work and leaving them to get on with it. You need a good understanding of the skills and capabilities of the person to whom you delegate responsibility and their limits. Coming to an agreement where the other person is working beyond their competence is unlikely to succeed, even if it gives you what you want in the short term.

It is important to have a clear understanding of what you want to achieve and how it is to be done before you start to discuss it with others. Be alive to the concerns of the other person you are dealing with. A good manager is also an active listener, able to understand what staff are really saying and act accordingly. The other person is also more likely to co-operate with you if they are left feeling they have gained something positive from the encounter.

Performance management

When you delegate a task to someone else, you have a responsibility to ensure the person is doing the work to your satisfaction. You will need to arrange for them to report progress to you, and you may need to direct their work periodically, if necessary. If you find they have problems with the work, not only will you need to make other arrangements, but you will also have to work with the person to improve their skills.

Improving performance is the lynchpin of management and involves meeting with your staff regularly to review their work, assigning them new tasks and checking on the quality of their work.

It is not advisable to manage the performance of individual staff in group settings as this can undermine confidence and may lead to tensions within your team. Instead, try to meet with staff regularly on a one-to-one basis, as often as weekly for direct reports. Regular one-to-one meetings can be used to review each individual’s work, giving you the opportunity to correct staff and where improvements do not occur with time, to discuss with them what to do next.

One of the most common criticisms of managers embarking on formal or disciplinary action with under-performing staff is that the manager had not told the staff member their performance was sub-standard or given them a chance to improve. Regular meetings give you the opportunity to tackle these issues. You should keep notes of what happens during such meetings.

Performance management will allow you and your staff to develop a clear picture of their development, teaching and training needs. You will also need to help staff formulate a personal and professional development plan. This should be done at least once a year, during their appraisal. For more information on medical appraisals, you may wish to refer to Drs Stephen Wilkinson and Kwee Matheson’s book, Appraisal for medical consultants - a handbook of best practice (2001).

Dealing with problem behaviour

While it is natural to want to avoid conflict, a good manager is one prepared to confront awkward situations, particularly in the area of personal conduct. Mention poor behaviour at the time it occurs, calmly and without anger. This is easier if mentioning poor conduct becomes a habit. The other person, when challenged, will nearly always apologise when told quietly that ‘this is not the way we do things here’, or that their conduct has offended or concerned you. Once they have been calmly reminded a few times, in most cases the behaviour will stop.

You also need to be alive to factors such as stress or health problems. Warning signs may include poor time management, lateness and excessive absence, failure to take regular annual leave or working excessive hours and deteriorating relationships with colleagues.

Where you need to have a detailed one-to-one conversation, you should spend a little time in advance preparing what you are going to say, and how you are going to say it. For example:

• consider a brief statement of the problem from your point of view and select a specific example to illustrate it;

• describe your feelings around it;

• clarify why it is important for you, for the team, or for the organisation;

• identify your contribution(s) to it and your wish to resolve it;

• get the other person to respond;

• enquire into their views using active listening techniques, ensure full understanding, and acknowledge their position and interests;

• ascertain what was learned: where are you both now? What is still needed for resolution? What was left unsaid that needs saying? How can you move forward?

• make an agreement and have a method to hold the person accountable for it; and,

• record your conversation and agreement and plan a time to review.

All consultants need to manage their teams effectively. Although you can use personal development time to acquire specific skills, most management acumen is learnt on the job through trial and error. However, by harnessing the listening and communication skills you already employ as a doctor, you are already well on the way to being an effective manager.

The MDU’s new consultant pack contains 18 factsheets on subjects such as communicating with patients and colleagues, good record keeping, supervising staff and marketing and media. The pack is available free to the MDU’s consultant members.

Dr Mike Roddis is a joint director of the company Healthcare Performance Ltd which provides coaching, workshops and consultancy to healthcare organisations. Mike, who trained as a pathologist, previously worked as a medical director at an acute trust for six years. He now leads the MDU’s workshop on preparing for your first consultant post.

Tags: ,
Posted in Guidance | No Comments »

Bristol trusts urged to end their pathology feud

By Francesca Robinson - 20th December 2010 1:10 pm

Warring pathology departments in two Bristol hospital trusts are to be merged following an inquiry which criticised damaging professional rivalry and jealousy between consultants.

The inquiry was launched by University Hospitals Bristol Foundation Trust (UHBT) after pathologists at the North Bristol Trust raised concerns about 26 possible cases of misdiagnosis between 2000 and 2008.

“We heard phrases such as ‘power struggle’, ‘playground behaviour’, ‘a Bristol disease which chips away at itself’ from various witnesses describing the relationship between the two trusts,” reported Jane Mishcon, chair of the inquiry panel.

“It will take strong management and exceptional clinical leadership to unify the two histopathology departments, but it can and should be done,” she said.

A review of the cases by the Royal College of Pathologists found that although diagnostic mistakes had been made by pathologists at UHBT, only a few were serious. Most errors were minor and of a type that could have been - and frequently were - made by any pathologist.

A further random selection of 3,500 samples were then investigated. Although the audit highlighted some areas of concerns about the working practices of the UHBT department - particularly sharing difficult cases, seeking second opinions and checking unexpected diagnoses - the service overall was deemed to be safe.

Mishcon said their main concerns were about the culture and attitude of “arrogance and excessive confidence” both within the two pathology departments and between the two trusts.

“We have observed a culture which is at times defensive, responds aggressively to criticism, is sometimes unwilling to acknowledge, let alone learn from, mistakes, and which is based on overconfidence bordering on arrogance,” she said.

Professional competition was healthy, but professional rivalry which damaged services, was not.

The inquiry criticised the unprofessional way that serious allegations about the competence of colleagues had been made in a letter which was copied to 14 separate individuals.

UHBT’s medical director Dr Jonathan Sheffield was also castigated for failing to initially take the allegations seriously because initially he believed they were “vexatious”.

The trust only took the allegations seriously after Bristol GP Dr Phil Hammond reported the allegations in the satirical magazine Private Eye in June 2009.

By this time the concerns had escalated out of all proportion and the already strained relationship between the two pathology services and between the two trusts became even more deeply entrenched. The lengthy and expensive inquiry would not have been necessary had the issues been dealt with when they were first raised, concluded the panel.

UHBT and the North Bristol Trust have now agreed to appoint a joint clinical director of histopathology to run a new integrated service. All future consultant posts will be joint appointments. The trusts have also agreed new procedures to ensure that concerns will in future be more rigorously and swiftly investigated.

UHBT chief executive Robert Woolley said: “The two trusts are committed to ending professional rivalry which works against the interests of patients. We now have a formal Partnership Agreement…enshrining principles of co-operation between us and outlining a number of areas for joint working beyond histopathology.”

He said they had already begun to act on the inquiry’s recommendations for improving the culture, attitude and working practices in the UHBT pathology department.

Tags: ,
Posted in Hospital Dr News | 8 Comments »

Medical students need more leadership training

By Mike Broad - 21st October 2010 11:03 am

Medical students need more non-clinical training, on issues like leadership and medical professionalism, a report claims.

The report, called 21st Century Doctor: Understanding the Doctors of Tomorrow, calls for more to be done to help medical students acquire the skills they will need to become future leaders of the health service.

Research among 492 medical students reveals that many are uncertain about their future roles in management and leadership and the skills they will be expected to possess.

A key finding was that ‘professionalism’ needs to be an integral part of medical education and training and medical students should have well-articulated and clearly defined definitions of it.

Furthermore, the terms ‘management’ and ‘leadership’ are often confused in the minds of medical students.

The report’s authors say important questions need answering about how medical students can best prepare for the increased responsibility they will face in managing and leading the health services of the future.

The report was supported by the Royal College of Physicians, GMC, King’s Fund, University of Liverpool, NHS Institute for Innovation and Improvement and Student BMJ.

Sir Richard Thompson, president of the Royal College of Physicians, said: “With the increasing importance of relationships with patients, carers, NHS managers and other health professionals, it is vital that our future doctors possess the necessary skills to lead UK healthcare.

“It is clear that students want to learn more about the non-medical aspects of a career in medicine, with over 80% of the medical students we consulted agreeing that doctors should be trained in leadership and management.”

The report also finds that students need clarification of the role and function of the GMC.

All medical students must meet the outcomes outlined in the GMC’s guidance Tomorrow’s Doctors. The guidance, which was updated in 2009, sets out the knowledge, skills and behaviours that students must learn at medical school and emphasises the importance of developing professional as well as clinical skills.

Niall Dickson, chief executive of the GMC, said: “This is an important report. We’re determined to act on what medical students have told us and do more to help them understand our role and support them to prepare for a successful career. The GMC has already begun to work with them to ensure they understand the professional standards that they need to adopt now to meet the challenges of the future.

“The GMC’s role has expanded to cover all stages of medical education and as a result of this and the introduction of revalidation, we aim to develop a closer and ongoing relationship with every member of the profession, from the first day at medical school until the day they retire from practice.”

Tags: ,
Posted in Hospital Dr News | 1 Comment »

Myers-Briggs should try running an NHS service

By Katherine Teale - 20th September 2010 9:16 am

I’ve got to be more positive. I know this because, as part of our clinical director training programme (or “brainwashing”, as it’s known locally) I’ve just got the results of a 360 degree appraisal, which can be summed up as “she’s OK but a tad pessimistic”.

Our facilitator told us that everyone has their own range of skills, some of which are “well-developed” and others are “areas requiring development” (formerly known as “weaknesses” though we’re not permitted to use that word).

In my personal report, which runs to 200 pages most of which I haven’t quite got round to reading, there follows several chapters of detailed bullet-points, which essentially I can boil down to the following: I need to try harder with A. denial in the face of overwhelming evidence of impending doom, and B. developing a delusion that everything is going to be fine. Either of these will allow me to spend the entire day in a state of euphoria, thereby carrying the team with me (at least those who haven’t succumbed to terminal irritation).

On top of this we’ve been put through the Myers-Briggs personality assessment, which assigns you four personality traits. There are 16 different categories, each comprising a different combination of these traits and, it’s fair to say that, statistically, my category is not particularly promising, at least as far as my clinical director training goes. Nationally, it’s neither the group which most successful senior managers belong to - nor, sadly (or possibly not so sadly) is it the one which generally describes most anaesthetists.

According to our facilitator, there are quite a few public health doctors in my group - but it’s a bit late for that now. In fact, I’m not quite sure where this leaves me, although it does perhaps explain why one of our ODPs recently described me as the “most untidy anaesthetist in the hospital”. I shall now be able to explain that it’s not my fault but down to my innate ‘N’ personality trait.

I felt quite relaxed and, I have to say, positive, after an entire day spent talking about myself - an activity which I rarely get to indulge in because it involves paying someone a large amount of money.

Now that I understand what my personality traits are and what 12 other people in the trust think of me, I can get on with trying to keep the place running.

More beds have been closed this week, and we’ve been desperately trying to discharge patients and keep the theatre lists going. The new computerised system is full of glitches, so that 20 patients weren’t admitted on the system and turned up in the admissions lounge without any records. Patients were complaining, and sister was in tears.

In fact, there was a worrying amount of negativity - obviously they have development needs focusing on denial and delusion skills. For a fee, I would be happy to advise them.

Tags: ,
Posted in Katherine Teale | 2 Comments »

Alternative guide to developing leadership skills

By Bob Bury - 8th September 2010 10:51 am

I’m sure that the guidance for consultants on developing leadership skills is well-intentioned, but I hope that Emma Sedgwick will forgive me if I say that it all sounds a bit too earnest to me.

It’s understandable, of course, because she’s much younger (and, I was going to say, certainly much prettier than me, but the Editor and his legal team tell me that I can’t say that because it’s condescending, paternalistic, sexist and slightly creepy). She’s also likely to be less cynical than me, so I thought I’d let you see my version of the guidance. You’ll notice that it has the virtue of being much shorter than the original.

Why develop leadership skills?

Why indeed?

Leadership framework

There are a number of different leadership frameworks which can help a consultant achieve their potential as an effective leader. One of the best known is the Advanced Rating for Supervisory Excellence (Jerry - you couldn’t come up with an easy to remember acronym for that, could you?). This was developed specifically for doctors by me and a bloke I met down the pub.

The framework is set around four domains:

1. Personal qualities - such as self-importance and acting with indecent haste.

2. Dominating others - ensuring that there’s none of that team-building nonsense.

3. Subverting services - ensuring that the outcome of any management change is financially beneficial to Number One.

4. Improving services - such as re-introducing the consultant dining room and serving heavily subsidised booze.

Personal qualities

Just as important as vision, direction and focus, a doctor needs an ability to bullshit. This is, of course, a necessary component of all medical care, given that most of the time you don’t have a clue what’s wrong with the patient sitting in front of you, but it’s also vital if you wish to be a leader. They’re not going to follow you if they get even the faintest inkling of where you’re going.

Identifying a leadership style

There are a number of leadership styles:

1. Overbearing

2. Vicious and overbearing

3. Vicious, threatening and overbearing

4. Surgical

5. Or, if you don’t enjoy bullying (although in that case, why are you doing this?) - John Terry

Why time management is a good skill to develop

Time is money.

Time management tools

1. Procrastination

2. Ignoring tasks

3. Prioritising tasks - frankly, you won’t need to do this. See 2.

4. Choose a role model - a good recent example would be those trapped miners in Chile.

5. Timing - we all have a time of day when we are most alert and efficient. For me, it’s 2.00am, which is a real pain in the arse.

6. Reward yourself at the end - sleep with a colleague’s wife/girlfriend (see John Terry, above).

You will no doubt think that this all sounds rather cynical and negative, and I’d have to confess that you may have a point. But it has served me in good stead, and I retire from the NHS at the end of the year with not a stain on my character (although I may have left several elsewhere).

Tags:
Posted in Bob Bury | 2 Comments »

Developing leadership skills - guidance for new consultants

By Dr Emma Sedgwick, joint director of Healthcare Performance - 29th August 2010 10:18 am

The MDU has developed new guidance for doctors embarking on their first consultant post. In the first of a series of articles guiding doctors through the common non-clinical challenges they might face, Dr Emma Sedgwick from Healthcare Performance, looks at some of the skills needed to become a successful leader.

Why develop leadership skills?

The GMC’s Good Medical Practice and Management for Doctors both recognise leadership as a key part of doctors’ professional work, regardless of specialty and setting. There are a number of specific skills associated with leadership which doctors can develop and improve.

Leadership framework

To be an effective leader, it is important to have vision, direction and clear focus on priorities for the organisation or department. There are a number of different leadership frameworks which can help a consultant achieve their potential as an effective leader. One of the best known is the Medical Leadership Competency Framework. This was developed specifically for doctors by the Academy of Medical Royal Colleges and the NHS Institute for Innovation and Improvement.

This framework describes the leadership competencies doctors need in order to become more actively involved in the planning, delivery and transformation of health services. The framework is set around five domains:

• Personal qualities - such as developing self awareness and acting with integrity.

• Working with others - such as building and maintaining relationships and working within teams.

• Managing services - such as planning and managing resources, people and performance.

• Improving services - such as ensuring patient safety and encouraging improvement; and

• Setting direction - such as making decisions and evaluating impact.

Personal qualities

Just as important as vision, direction and focus, a doctor needs a good understanding of their own approach and style of working. There may be many things a consultant does not have absolute control of in the workplace such as team size, the level of resources and the demand for services. But a consultant can choose how to approach and respond to professional challenges.

Identifying a leadership style

There are numerous theories on the topic of leadership and leadership styles. Different situations demand different leadership styles. There may be times when an authoritative style is appropriate, and others when a more participative style will be better suited to the task at hand.

Developing flexibility in leadership can be the greatest challenge: knowing when to use different skills in the different situations is sometimes described as the mark of an effective leader.

Developing leadership qualities

A consultant may want some help identifying their own leadership style. There are a number of ways this can be approached such as finding out how the framework mentioned above can be applied, developing greater self-understanding by taking one or more psychometric tests - such as the Myers Briggs type indicator, or participating in a formal leadership scheme, or employing a career coach.

Why time management is a good skill to develop

Time is a limited - and therefore precious - resource. Effective leaders need to be able to manage their limited time. Developing techniques for using time more effectively can have beneficial consequences, for example it can help a doctor to achieve a good balance between work and home life.

Time management tools (adapted from Mind Tools)

1. Overcoming procrastination

The greatest enemy to effective time management is procrastination. We’re all familiar with the notion that when you should be doing something you don’t want to start, any lowly task can seem more attractive. Once a doctor acknowledges that they’re procrastinating there are techniques they can apply to overcome these hurdles.

2. Break the task into smaller chunks

To overcome feeling completely overwhelmed, break the task down into smaller tasks. A doctor can then start with the smallest and easiest task. Once that has been achieved - even if it’s a small part of the whole - a person feels better as they’re on the way. So, for example, instead of thinking “I will write the whole of the report this weekend”, list out the component parts which make up the whole task - for example, the background, methodology, findings and conclusions. Each of these areas can be further divided into even smaller, more manageable chunks.

3. Prioritise tasks

If a consultant is looking to concentrate on a particular project they need to look at scheduling their time. They should look at the available time by day, week or over the coming month. Next, they need to list out all the various tasks to achieve the goal and break these down into smaller tasks. Then the doctor should consider which tasks are both the most urgent and the most important. The truly urgent and important tasks should be scheduled in first. The least important and least urgent tasks should be scheduled in at the end, when the doctor has achieved the others. Using this technique a busy person should find it easier to fit in everything you need to do.

They should also try to avoid switching between tasks. It is tempting for consultants to keep checking emails, for example, and therefore getting distracted from what they’re really doing.

Once the tasks have been planned and prioritised, the doctor can ask someone else to hold them accountable. Getting a good friend or relative to ring or email the person to ask if they’ve completed the task yet can help.

Consultants can also cost out their time. They should consider how much their time is worth per hour, then add up how much time, and therefore money they’re effectively wasting by not getting on with the task in hand.

4. Choose a role model

Chances are a more experienced colleague is very organised and good at using their time. They effortlessly manage a number of different things at the same time, do them well and meet deadlines. Ask the person you know how they do it and learn their tips and solutions for time management. These tips should be put into practice and, if necessary, they can be asked for more information and the recipient can further refine their techniques.

5. Timing

We all have a time of day when we are most alert and efficient. A doctor should find out when theirs is. It may be first thing in the morning, or late at night. It doesn’t matter when it is, just exploit the times when you can really focus on work and get far more done.

6. Reward yourself at the end

If you need to tackle an unpleasant job, focus on the outcome and set yourself a reward for when it is completed. Try to imagine what it will be like when you have done it.

Consultants should remember that even small changes to the way they manage their time can have a significant impact.

The MDU’s new consultant pack contains 18 fact sheets on subjects such as communicating with patients and colleagues, good record keeping, supervising staff and marketing and media. Part one of the pack covers leadership skills and is available free to the MDU’s consultant members.

Dr Emma Sedgwick is a joint director of the company Healthcare Performance Ltd which provides coaching, workshops and consultancy to healthcare organisations. Emma, who trained as a child and adolescent psychiatrist, previously worked as a medico-legal adviser at the MDU and now leads the MDU’s communication skills workshops.

Tags: ,
Posted in Guidance | No Comments »

Doctors urged to take up leadership roles

By Mike Broad - 1st June 2010 11:35 am

Doctors are being urged to take up leadership roles in medicine and public life by the Royal College of Physicians to improve health outcomes.  

Its report, Future Physicians: changing doctors in changing times, says doctors are in an ideal position to drive positive changes in healthcare over the coming decade.

The working group behind the report investigated change in health services, economics and information and communication technology.

They conclude that healthcare costs are likely to increase faster than the growth in national income, forming an increasingly large part of the economy. Demand for doctors will remain strong and they’ll be expected to play a central role in doing more with less.

Increased access to health information will change the doctor/patient relationship, as doctors play more of a role in interpreting and managing information.

Clinical decision-making will be affected by increased scrutiny, guidelines and budgetary considerations and there will be more focus on CPD and re-accreditation.

Technology is likely to affect communication, workflow and relationships, and the latter has the most potential to engage patients in the process of creating reliable healthcare.

In this changing environment, physicians of the future need to be properly equipped to continue to meet the needs of patients.

The report calls for a commitment to leadership - in health, policy and politics - in order to accelerate improvement in health outcomes. And there needs to be engagement with areas of public policy that seek to reduce health inequalities, improve wellbeing and promote understanding of health.

New information technology needs to be embraced, it says, including the research potential of nationally coordinated electronic records.

The profession also needs to engage fully with patients, their organisations and the health service to develop valid performance measures that are clinically meaningful and improve patient care.

Prof Ian Gilmore, president of the Royal College of Physicians, said: “This report traces out the stark challenges facing health and healthcare for the next generation and it clearly identifies medical leadership as one of the key solutions. Doctors must be prepared to take a lead, not just in developing their own clinical services but in shaping the wider landscape on which our futures depend.”

Peter Smith, professor of health policy at Imperial College London, added: “The key challenge facing the NHS is how to reconcile ever-increasing demands with constrained resources, a dilemma brought into very clear focus by the impending financial austerity. This report highlights the crucial responsibility that doctors have for ensuring that NHS money is spent wisely. How doctors respond to the challenge will have a major influence on the shape of our future health services and the wellbeing of the country.”

Read the full report.

Tags:
Posted in Hospital Dr News | No Comments »