Posts Tagged ‘Management’

Advice on organisational skills and managing meetings

By Dr Mike Roddis, Healthcare Performance - 12th May 2011 10:07 am

The MDU has developed advice for doctors embarking on their first consultant post. In the sixth article in this series guiding you through the more common non-clinical challenges a consultant may face, Dr Mike Roddis from Healthcare Performance Ltd, discusses organisational techniques that may help a consultant in their new role and looks at how managing a meeting in the right manner can ensure its success.

As a qualified doctor, you are likely to have developed good organisational skills during your training. In a high pressure, challenging consultant role, these skills will be ever more important and it is wise to develop them so that you can carry out your role to the best of your ability. When attending or chairing meetings, be they clinical or managerial, good organisation and management can make a meeting both productive and useful.

Managing informal meetings

Informal and one-to-one meetings form an important part of day-to-day life in hospitals. They provide an effective way to manage the performance of departmental staff and a good way to communicate with other hospital staff.

Although the meeting may be informal, it is vital to stay focussed. Rules of courtesy and professionalism apply at all times. It’s important to keep a record of the meeting, especially if serious issues are discussed. The date and time of the meeting, those present, topics covered and items agreed should be kept note of. Many managers opt to email attendants after the meeting. This is useful so that everyone understands what was said.

It is common practice to make records of clinical interventions, but making notes of what was discussed at a meeting can be just as important as it can remind those in attendance what was agreed and avoid misunderstandings.

Managing formal meetings

Formal meetings in the NHS, such as board or committee meetings, usually have fixed agendas and you may be asked to attend in your role as consultant, even if you have little direct involvement in what is discussed. It is important to remain professional and businesslike at all times and make appropriate contributions.

Often chairs of these meetings are looking for people to take on other tasks such as running sub-groups or projects so it is helpful to show knowledge and build a good reputation.

Chairing meetings

Whether a formal or informal meeting, good chairing skills are vital in ensuring meetings are effective and productive. A meeting should have a well-defined purpose, with clear objectives set out in writing. Additionally, the length and frequency of such meetings should be planned in advance.

It is easy for meetings to drag on longer than is necessary. This should be avoided. It is also important that numbers of attendees are kept to a minimum and only those required should be invited. This helps to keep the meeting efficient and on track.

A written agenda including a scheduled start time and expected end time should be provided in advance so attendees know what to expect. Important issues should be covered first to make sure time does not run out and you should try to ensure meetings do not last longer than an hour. The agenda should be read beforehand and any actions from the last meeting should have been completed.

It is important to establish some ‘house rules’ for behaviour. For example, it may be wise to have a rule stating there should be no interruptions and that only one person speaks at a time. Disruptions should not be allowed and people discouraged from taking calls or answering bleeps. Once the meeting is complete, it is useful to remind attendees of the next meeting. If people seem distracted towards the end consider shortening future meetings. By agreeing a finish time in advance and keeping to it this is less likely to occur. Following the meeting, minutes should be circulated containing clear notes of actions and timescales for reporting back.

Managing upwards

When embarking on your first consultant post, one organisational skill you will need to master is managing relationships with those above you. To do this effectively it is helpful if you understand the role and function of senior managers in the workplace as well as the pressures they are under. Furthermore, demonstrating a willingness to engage with their concerns is likely to work to your advantage. This allows better relationships to be built with the senior management team - which may make them more amenable to your needs.

Strategic development

As a specialist in your field, you may be asked by the board for your input into the development of services and you may also be required to become more involved in the strategic development of your workplace. To do this, you will need to have a clear idea of where your trust is currently placed, including how it is perceived by patients, GPs, and other healthcare providers and where it hopes to be in the future - whether demand for services will change for example.

Business case development

When change is needed, you may need to make a business case to the trust - for example, for more resources for your team. A business case should be in line with your trust’s overall strategy and should follow the same principles, considering:

1. Where are we now?

2. Where do we need to be?

3. How are we going to achieve our goal?

In order for a case to be approved it must demonstrate the need for change and provide evidence to back up any assertions.

Workforce planning

You may become involved in planning staffing for your team now and in the future, to ensure shortfalls are avoided and that the team contains the right skills mix. For example, will a new technique require nurses to do work currently undertaken by doctors?

Financial skills

You may be asked to manage a departmental budget for the first time. Theoretically, this is no different from managing a household budget. Including the hidden extras such as National Insurance contributions, staffing costs make up about three-quarters of total departmental expenditure. Management accountants in your trust will be able to advise you on how best to manage your budget statements.

Taking on the role of consultant will bring fresh challenges and represent a learning curve for any doctor. Although you are already likely to have developed organisational and management skills, perfecting these and building upon them is key to ensuring your fulfil your role successfully and that the trust can thrive.

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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.

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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.

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GMC hasn’t proved the case for revalidation

By Tom Goodfellow - 8th June 2010 9:04 am

So, the world has changed again. Locally our trust has lost yet another chief executive at no notice, and nationally that nice Mr Lansley has told the GMC to defer the introduction of revalidation for another year. Let’s look at the issues separately. 

When I became a consultant, in 1989, my first CEO was the longest serving in the same hospital in the history of the NHS. Seventeen years; a record which I doubt has been beaten. He was a pit-bull in many ways (without the lipstick) but I suspect a pussy cat at heart, and although he scared me a bit I always got on well with him and learned a lot. However after 17 years you make enemies and he sure had plenty. His fall was a bit like watching the last few months of our late Prime Minister, fighting like a wounded animal, but still insisting to the end that he was right. (Since then he has proved a highly successful CEO in a neighbouring trust).

Since then we have had a succession of CEOs (five or six I think), all worthy people in their own way. But the ever-changing goal-posts of high NHS politics coupled with a top-down, bullying, target-driven management culture always defeated them in the end. Since I no longer have a management role I was only superficially acquainted with the most recent so I pass no judgement and wish him well. But I do say that 18 months is much too rapid a turn-over for such a crucial role. I do not know the back story behind his departure (there surely is one) but his farewell statement, posted on the trust website, makes fascinating reading: “I will be working at the strategic health authority, taking forward the work I have been undertaking as regional lead for equality and diversity.” Deconstruct that if you can!

I await the appointment of his successor with interest, but at a crucial time for the organisation we again seem rudderless.

The intervention of the new Secretary of State for Health in the revalidation debate in fact comes as no great surprise. The HCSA executive committee (of which I am a humble member) had heard rumours, well before the election, that the Conservatives were fairly cool on the matter. The issues of concern are obvious - the burgeoning bureaucracy and costs both in terms of financial support for the programme plus the loss of clinical time - against the lack of any objective evidence that the process had any proven benefit or merit and a challenging financial climate.

I have personally spoken and written against the GMC proposals in various places for some time. The HCSA has also made the concerns of our membership known, both in response to official consultations and also in a face-to-face meeting with Lansley last year.

Of course professional regulation is important to protect the public from the very small number of rogue doctors. However, I do not think the GMC have proved their case for the current proposals, and they have certainly failed to take the profession with them despite heavy marketing.

Twelve months gives all parties breathing space for re-evaluation. I will be interested to see what emerges.

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Step forward all those wannabe chief execs

By Mike Broad - 11th May 2010 11:17 am

Trusts and regulators are seemingly obsessed with creating leadership development strategies at the moment. It’s partly a response to Darzi’s next stage review which sought to place clinical leadership at the centre of reform. And also because of a belief that good leadership will somehow compensate for the £20bn that’s got to be sliced from the NHS budget over the coming years.

So, every man and his dog is excited about fashioning great clinical leaders.

Monitor, the foundation trust regulator, has been in enthusiastic talks with the Treasury over funding for a business academy to train clinicians for senior management roles. Though I’m sure one is probably more enthusiastic than the other.

And some trusts have really got carried away with it. Staff at the West Midlands Ambulance Service were asked whether they thought Adolf Hitler was cool on a scale of one to five, as part of a Making Leadership Cool survey intended to help shape (yes, you guessed it) another leadership programme. The NHS may need a few Richard Bransons but, please, no more fascists (ooh, but they do make the ward rounds run on time, etc).

A serious study exploring the barriers to clinicians taking on senior management roles has also been released recently. It offers lots of sensible suggestions as to how the path could be cleared. These include better training, mentoring, a leadership faculty and better recognition for management through clinical excellence awards.

But an essential point is being missed in all of this. Doctors are not becoming medical directors or chief executives because of a lack of opportunity; they’re not becoming medical directors or chief executives because of money. They are reluctant to become medical directors and chief executives because of roles themselves.

Most would sensibly prefer to pull out their own finger nails with a set of pliers.

They’re terrible roles, high in risk and pressure and yet mired in bureaucracy, interference and petty politics. You can create all the academies you like but until this fact is recognised there will be no great influx into senior management  by consultants.

I’m sure there are many great clinical leaders out there operating at CD level but few will step up to organisational roles until they see the current incumbents either enjoying themselves or making a real difference.

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Monitor discusses clinician business academy

HSJ - 10th May 2010 9:02 am

Monitor has been in talks with foundation trusts and the Treasury over funding for a business academy to train clinicians for senior NHS management roles.

The scheme is the idea of outgoing Monitor director of policy Robert Harris. He said the plan was about “putting people who are clearly clever in charge of these devolved budgets and incentivising them to manage”.

He said: “Then we will get more for the same money or, Nirvana, more for less money.”

But he added: “The spend-to-save argument is always a tough one to win, I have been on a charm offensive. As soon as the benefits are there to be seen, the vast majority of foundation trusts have said ‘we will fund that’.”

As well as sounding out foundations, he said he had also been working for the last nine months with the Treasury to secure initial funding to set up the academy.

Professor Harris said it would not be a bricks and mortar institution but would be delivered “in the field, where it is instantly valuable”.

Read more at HSJ.

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Barriers to career progession for medical managers

By Mike Broad - 8:26 am

A new study involving 22 trust chief executives with medical backgrounds provides important insight into medical leadership within the NHS.

Medical chief executives in the NHS calls for a more structured and systematic approach to medical leadership and suggests that the days of the ‘keen amateur’ are numbered.

It was commissioned by the NHS Institute for Innovation and Improvement and the Academy of Medical Royal Colleges from the Universities of Birmingham and Warwick with the aim of learning about the career paths taken by medical chief executives.

The study was undertaken in response to Darzi’s High Quality Care for All: NHS Next Stage Review Final Report, which emphasised the need for NHS reform to be locally led with the full engagement of clinicians, including doctors.

The study shows that the career paths of medical chief executives are highly variable with some becoming chief executives relatively early in their careers and others being appointed much later.

There has been little if any structured support for doctors who wish to take on leadership roles within the NHS. Some of those interviewed reported that, in the absence of structured support, they had benefited from advice and guidance from senior colleagues.

The training received by medical chief executives is highly variable and often involves learning on the job rather than more formal development.

Most of the medical chief executives (17 of the 22) gave up clinical commitments on becoming chief executives, either out of choice or because it was impossible to continue.

The study shows that an important motivation for becoming a chief executive is the opportunity to make a bigger difference than is possible in clinical work.

The chief executives reported that their experience was generally positive, although thre were greater insecurities than being clinically focused. The short tenure of many chief executives in the NHS was felt to be a major deterrent to more medical leaders putting themselves forward.

Pay differentials between chief executives and senior doctors were also considered to be relevant to the number of doctors wishing to become chief executives, as was lack of recognition of leadership roles in clinical excellence awards.

The study suggests a number of changes need to happen to support doctors to become chief executives in future:

• strengthen career planning, training and development, including the use of coaches and learning sets;

• develop clearer career paths that enable doctors to see how they can gain experience in different roles on the way to becoming chief executives;

• use existing medical and non-medical chief executives as role models, mentors and advisers;

• review pay differentials and use clinical excellence awards to recognise the contribution of medical leadership where appropriate;

• consider the establishment of a faculty of medical or clinical leadership to address the question of professional identity and to promote high standards of practice;

• develop a framework for continuing education and professional development that defines the competences and skills needed by medical leaders; and

• enable medical chief executives to undertake clinical retraining as happens in Denmark, should they wish to return to clinical work.

The clear message from this study is that the time has come to adopt a more structured and systematic approach to developing medical leadership in the NHS.

The NHS will only be able to rise to the challenges that lie ahead by ensuring that the work being developed by the National Leadership Council is translated into a practical programme of support for the future.

Read the full report.

Read more about the MSc in Medical Leadership.

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What would Noel Coward say on being a doctor?

By Stephen Campion, HCSA chief executive - 24th March 2010 11:21 am

The trouble with going on holiday is that when you get back you need another one to recover from the backlog! Actually that is unfair to the HCSA team who provided a seamless service whilst I was away. On reflection, the more depressing aspect of getting back is to find that nothing has changed: the same old problems remain. 

Consultants facing a pay freeze (or a cut in real terms), and Machiavellian management styles from aggressive trust regimes, would perhaps have some empathy with Colin Tucker brought in to turnaround the Social Services Department in Birmingham. In an honest appraisal of what had gone wrong in social services he said on Radio 4’s Today Programme that he would not want one of his children to become a social worker in today’s climate.

Noel Coward had flair with words and music, as the ditty ”Don’t put your daughter on the stage Mrs Worthington” demonstrated. But I wonder what advice he would have given to her if she decided that her daughter should become a hospital doctor instead? Something like this perhaps:

Don’t put your daughter into medicine, Mrs Worthington,

Don’t put your daughter into medicine,

The profession is undervalued

And a consultant’s life is tough;

I admit the fact she’s bright

And yearns to treat patients right

But she will for ever be a trainee at night.

 

She has nice hands, to give the wretched girl her due,

Quite dexterous from a surgical point of view

But in years of validation

And control beyond imagination

They will soon become hard

With no time for preparation,  

As management find ways of

Reducing SPA’s by two.

 

If targets are her thing

And performance the “be and all”

Then who knows she may walk tall.

But if she wants a life of fun

When her life has just begun

Do you want her reduced to tears

As the pressures take their years?

Then I repeat

Mrs Worthington,

Sweet Mrs Worthington,

Don’t put your daughter into medicine!

Now Mr Coward - what about Mrs Worthington wanting her daughter to be a lawyer or accountant?  

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More inclusive management needed in the NHS

By Mike Broad - 22nd March 2010 1:24 pm

A minority of NHS staff feel that healthcare professionals and managers work well together, the annual NHS staff survey reveals.

While 70% of staff could identify who the senior managers are in their trust, only 27% felt that their managers involved staff in important decisions. Only 36% of staff felt that managers encouraged them to suggest new ideas.  

The survey, which received 156,951 responses, does reveal that the majority of staff were satisfied with the support they receive from their immediate managers.

Seventy percent of staff felt able to make suggestions on how they could improve the work of their team or department and felt that they have frequent opportunities to show initiative in their role.

The report authors said: “It is very positive to find that 90% of all NHS staff feel that they are making a difference to patients and that the majority say they have rewarding jobs.

“However, while most staff work in teams, many of those teams do not appear to work as effectively as they could (with only 40% saying they work in a team which has clear and shared objectives, which meets regularly, and which reviews its performance). As in previous years, a large minority of staff said that they don’t have enough time or that there aren’t enough staff to enable them to do their jobs properly.”

The survey is commissioned by the Care Quality Commission. Its results are used to inform the public, regulatory activities, such as monitoring compliance, and Department of Health policies.

It also shows an improvement in the proportion of staff receiving appraisals, up from 64% in the 2008 survey to 69% this year, and increases in the proportion of staff saying these appraisals were effective and that they received the training, learning and development that was identified.

Read the full results of the NHS staff survey.

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The clinical director’s survival guide

By Katherine Teale - 10th December 2009 1:12 pm

Being a clinical director is like being the manager of the England Football Team (minus the huge pay packet) - everyone thinks they could do a better job until they find themselves in the hot seat. 

Having been a clinical director for two years now, these are some of the hard lessons I’ve learned. 

The first thing to remember is that it’s your fault - even if you weren’t in the hospital. Get used to saying sorry.

Learn the four essential rules of email:

1. To avoid extra apologising (see above) always check your facts thoroughly before sending an angry email. Better still, don’t send angry emails.

2. Never say anything in an email that you wouldn’t mind everyone in the hospital reading - because there’s a fair chance that they will.

3. The chance of an email achieving its purpose is inversely proportional to the number of people copied in. Some things are best discussed face-to-face. The only emails not copied in to 50 other people are thanking you for something which has gone well (very rare). Emails pointing out some gross failure on your part are always copied into half the hospital.

4. To avoid email overload, some emails may safely be deleted immediately - these include any which contain the words “it’s unacceptable” (translation “ I  personally don’t like it but can’t actually come up with any coherent reasons”), or “it’s a disaster waiting to happen” (ditto), or any mention of the word “status” (they’ve obviously lost the plot completely). 

Then comes mobile phone etiquette. If answering calls on the rare occasions when you’re not at work, always say you’re “off-site”. Never admit to being “at home” - clinical directors aren’t supposed to have them - nor is being “on holiday” considered an acceptable excuse for being uncontactable. Try to give the impression that you’re at an important meeting at PCT headquarters. 

Learn to accept that it’s virtually impossible to change other peoples’ behaviour, however irrational. You can only change your reaction to it. The following responses, though tempting, are not recommended: screaming, weeping, physical assault, or any combination of the above. The only sure-fire way of persuading colleagues to change their behaviour (i.e. holding a gun to the head) is unfortunately frowned on by HR.

Be grateful that you still do your day-job at least part of the time, and so have a get-out clause. Giving anaesthetics is great - I know what I’m doing (more or less), get instant results, and people are occasionally grateful. How different from the daily grind of the full-time manager, who has no relief from the tyranny of meetings, angry emails and conflicting targets.

Overall I’ve learned that most colleagues, from support workers to consultants and managers, are decent, hardworking folk who try their best most of the time. When people behave in an apparently irrational way, it is not (always) simply to annoy you, but generally due to some underlying problem which is nothing whatever to do with the matter in hand. Understanding this can save you a lot of aggravation. 

Finally, there are two areas of personal development which are essential to the survival of all successful clinical directors: firstly, a good sense of humour; and, secondly, friends outside work. You’ll need both in spades.

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