The report by Lord MacLean into the C. difficile outbreak at Dunbartonshire’s Vale of Leven Hospital between 2007 and 2008 makes for uncomfortable reading. NHS Greater Glasgow and Clyde has apologised unreservedly for a “terrible failure”. Of 143 patients who were identified as having contracted the infection C. diff was defined as a contributory factor in 34 deaths – a figure which is probably an underestimate according to Lord MacLean.
Processes for infection prevention and control before and during the outbreak are described as being dysfunction, with emphasis placed on the essential requirement for “an effective line of reporting, accountability and assurance”. Poor leadership among NHS GGC managers is cited as contributing to the situation where inexperienced junior doctors had too much responsibility and consultants were stretched. The report concludes with a broad range of 75 recommendations in total.
The Vale of Leven Enquiry is a hot topic which any doctor preparing for medical interview would do well to be familiar with.
It’s worth noting that the era in question overlaps with the events of the well-publicised Francis Report into the events at the Mid-Staffordshire Trust and that a great deal has been has been learned and changed since these events. While these reports throw the spotlight on the NHS of 7 years ago, the topics raised must be kept front of mind in order to drive the maintenance and improvement of standards today. Regressing to the issues of this era cannot be an option.
The point about inexperienced doctors with too much responsibility reminded me of discussions on the topic of effective delegation which took place last week during one of our medical leadership and management courses.
There are many reasons why delegation of a task should happen: it allows us to achieve more than we could on our own; it saves us time or enables us to concentrate on other tasks; it enables patients to be attended to in the time required; it spreads workload; it can enable development and growth for the person we are delegating the task to.
When we have a tasks to be delegated the question: “Who will be the best person for the job?” should be balanced with “Who will the job be best for?” The manner in which the delegation takes places should then be determined by the consideration of the person’s experience and confidence – the requirements of the discussion to pass a task to someone with good experience and confidence will be significantly different from passing the same job to someone with little experience or who may have low confidence. In either case the task and the level of performance expected must be clear and follow up to review progress and achievement is essential – otherwise this would be an abdication of task which is quite different to delegation where accountability is retained.
Every doctor, regardless of seniority, must be able to delegate effectively. The alternative is an unrealistic world where the doctor works in total isolation from anyone else and conducts even the most menial task on their own.
The doctor’s approach and management of delegation, like any other skill, should be regularly reviewed and refreshed.
