What makes a great locum?

What are the attributes that make the difference between great and someone to just fill a gap?

Locum doctors are essential for ensuring continuity of healthcare. They fill the gaps that arise due to unplanned absence, holidays, unfilled vacancies and help address any fluctuations in demand for care. At present, it’s fairly easy to draw a parallel between the locum role and the short-term redeployment that many doctors are experiencing during the current pandemic. Clinical competence is a must. But what else does it take to function well in a temporary position. What does it take to be a really great locum?

I recently discussed this question with two senior members of Athona Recruitment: Rebecca Coates, Sales Director for Psychiatry and Tanya Ironmonger, Sales Director Acute Medical Team. As an agency with a focus on quality, they were able to share their insights drawn from the feedback they seek from the teams and organisations they support.

Why locum?

Rebecca’s first observation was about motivations. There are many good reasons for a doctor deciding to take on locum work. They may be driven by specific family circumstances or to fit with a positive lifestyle choice. It may well be a career development choice. Some want to gain experience of working with a different patient demographic or try out a different geographic location. Some want experience of working in a different sized organisation, with different equipment or where there is opportunity to focus on a specific interest. Motivations matter as they inevitably inform attitudes and behaviours.

The proactive team player

Tanya raised adaptability as an essential requirement. Any reasonably established team will have developed ways of working and internal processes. The arriving locum must take proactive steps to clarify how the team works: who is responsible for what; what should be left where; what are their current challenges; how are they trying to solve them; and how they will support continuity of care after their placement ends.

So, we all agreed a great locum must be a great communicator. They must ensure that everyone concerned hears what needs to be heard – and that includes themselves. So, they must be able to get their message across and, at the same time, genuinely listen to their colleagues. This becomes a critical requirement if the locum recognises a problem, something which could be improved or is creating a risk. They must be able to raise issues and offer feedback to their temporary team in a constructive manner. In addition, they must know how to effectively escalate issues if they identify something which is definitely wrong.

A positive environment for a locum

We then discussed the fact that a locum’s performance is dependent on the other factors. Yes, as a temporary team member, they must have the right attitude, be adaptable and communicate effectively. However, the way that the permanent team welcomes and interacts with their temporary member is equally important. How can you expect the locum to know the team’s goals, processes or members’ roles unless it is explained to them?

So, the best teams ensure they welcome their temporary colleague and share this information. Their attitude is that this is someone who is supporting continuity of care, rather than a transient stop-gap. And they value the fresh perspective that the locum may have as a fresh pair of eyes on the way they are working. So, they ensure they review their experience together for mutual learning.

Development requirements

It follows that all doctors, however senior or junior, locum or substantive, need to become experts at forming and maintaining teams. These are skills which must be developed and refreshed throughout any career. There are clear benefits all round for patients, staff and organisations.

What are you doing to develop your team interaction skills?

Stephen McGuire – Managing Director

Oxford Medical are offering a 10% discount on any purchases made during February 2021 by doctors registered with Athona Recruitment.

How loud is your leadership?

What exactly is leadership? How do you interact with people to get things done? Is there just one “right way”, or is there a range of alternatives? Do you simply copy those around you, or have you developed your own approach that aligns with your personality and values? These are questions that we regularly explore during our 1-day Essentials of Medical Leadership & Management courses.

Watch this short video created for BBC Ideas by Dr Jacqueline Baxter, Associate Professor Senior Lecturer at the Open University and consultant tutor. It explores “the power of quiet leadership” and will provide you with some real food for thought. It’s is very relevant for doctors, especially in the current stressful circumstances.

So, how loud is your leadership?

Stephen McGuire – Managing Director

Need a course by a deadline?

Sometimes, deadlines seem to appear out of the blue. Sometimes, we know they were coming but have crept up on us while we were busy doing other things. And sometimes, we discover that it’s not possible to do what we thought would be straight-forward within the time available.

At Oxford Medical Training, we’re getting a lot of calls from doctors who want or need to take a course by a deadline. It may be for an application for a training post, for an appraisal or to complete a training programme. the good news is that we are running more courses than ever. But these courses are also booking up faster and further ahead than ever. We take it as a great compliment that so many are trusting us with their development requirements. Unfortunately, some doctors are disappointed to find that we are fully booked for the courses they want to take in time for their deadline. Does this apply to you? What can you do?

Solution #1

Over the past few years, we’ve developed our range of Online Courses. There are a broad range of subjects to choose from including:

These provide you with the opportunity to gain instant access to an accredited course. You work through the material on your own and you should expect to spend around around 2-4 hours to complete. We list the estimate times on the relevant course pages on this website. Once you have finished, you send us your Reflective Learning Statement or Workbook which you find within the course and we return your CPD certificate. So that’s a quick way to gain evidence of training with a certificate for 2-3 CPD points, dependent on which course you take. And if you want to study more than one topic, then our Online Career Development Bundles are an excellent cost saving option.

Solution #2

You can still book a course in our Virtual Training Room for a date that is later than your deadline. When you do this, you also receive instant access a relevant Online Course as part of your package. So you can complete the Online Course immediately and gain a certificate as described above. You can then also use your booking confirmation as supporting evidence for your application or appraisal. Once you have participated in the Virtual Training Room course with a tutor and a group of other doctors you receive another CPD certificate. This means you have two separate certificates as the Online Course and Virtual Training Room Courses each have their own distinct accreditation.

And if you keep missing deadlines?

Well, that could be a sign that you need to do a bit of work on your time-management skills! And we can help you there too because that’s a topic we focus upon in our Practical Leadership & Management Course for Doctors.

Courses are booking fast. So if you can see a date available for the subject that interests you, it’s better to book your place sooner, rather than later.

Stephen McGuire – Managing Director

Training options during the COVID-19 pandemic

Updated 30th October 2020

The current coronavirus pandemic has affected numerous aspects of life in the UK. For many doctors, this has meant significantly increased workload. For some, it has meant disruption to training programmes, cancellation of exams and interviews, or redeployment to an unfamiliar role. As the situation continues to change, many interviews, meetings and reviews are being conducted via online video conferencing. The GMC and AoMRC have also said they are determined to ensure the longer term needs of doctors in training are not compromised. New or demanding situations mean proactive skills development is as important now as ever.

At Oxford Medical we remain committed to supporting your professional development while at the same time protecting the safety of our delegates, tutors and partners.

What training options are Oxford Medical providing?

With the resurgence in prevalence of the virus the government has updated its guidance. In response, we are focusing on providing you with two key training formats to choose from:

  • Virtual Training Room courses continue as normal with a large selection of dates to choose from.
    • These courses provide you with an interactive group-learning experience facilitated by an appropriate tutor from our faculty.
    • You participate on the course from the safety and comfort of your home or office via secure video conferencing software.
    • Our Virtual Training Room provide you with an identical CPD accredited certificate as you would receive if you attended the same course at a physical location.
    • Click here to see available dates for courses on interview preparation, communication, teaching, leadership and management skills.
  • Online Courses: Availability of our full range of CPD accredited online courses continues as normal.
    • These modular courses enable you to learn whenever you want, wherever you want and at your own pace.
    • Subjects now include interview preparation, communication, teaching, leadership and management skills.
    • We also offer our online courses collated together in bundles which both save you money and broaden your learning experience.

We had resumed running in-person courses where it was safe to do so at appropriate locations. However these have been put on hold again for the time being. All courses which we normally provide in-person are available via the safety and comfort and convenience of the Virtual Training Room format which provide you with an identical CPD certificate. Click here to find your course, check available dates and book your place.

We have been able to continue delivering excellent standards of service throughout the lockdown period. This has included providing appropriate solutions for doctors whenever plans have had to change. Read our unedited reviews on TrustPilot.

When will you update your advice?

We will continue to update the information on this statement page as and when there is any change in the advice issued by the UK Government. This will include our safe-guarding measures which will be put in place whenever we are able to resume in-person courses.

Stephen McGuire – Managing Director

5 hitmen and delegation by doctors

5 hit men

The winners of the 2020 Ig Noble Awards have been announced. If you are unfamiliar with this interesting alternative to the prestigious Noble prizes, the “Igs” are awarded annually for research and “achievements that first make people LAUGH, then make them THINK.” News media have followed the ceremony with a range of amusing reports. They include identifying what happens to an alligator’s “voice” when it inhales helium. Then there’s the Ig Noble Peace Prize. It’s goes to rival pair of governments for encouraging their diplomats to ring each other’s doorbells in the middle of the night, then run before the door is answered. And a collection of world leaders are now the bemused recipients of the Medical Education Prize. Their achievement? “…for using the Covid-19 viral pandemic to teach the world that politicians can have a more immediate effect on life and death than scientists and doctors can.”

As they say, research and achievements that make you laugh and then think!

Time to laugh

This year’s Management Prize is an interesting one. Ig Noble have awarded it to five professional hitmen who participated in a dark but comical conspiracy. Here’s a quick summary of the hit that never was.

  • A shady business man, Qin, paid a hitman, Xi, a total of 2,000,000 yuan to assassinate his business rival, Wei.
  • But Xi kept half the money and paid Mo 1,000,000 to do the deed.
  • Mo then sub-contracted Yang-KS for the job and kept a share of the fee.
  • And Yang-KS did the same by passing the job onto Yan-GS.
  • Next, Yang-GS paid Ling 100,000 to complete the hit. That’s just 5% of the original contractor’s payment.
  • Ling met Wei, the target, told him of the plot and they faked the assassination.
  • Wei went into hiding while Ling sent the “evidence” back up the chain of command.

Everyone’s a winner! It could be the skeleton for the mad-cap, feel-good movie of the year. But, as Ig Noble say, some things that make you laugh and then make you think.

Time to think

So, what does this remind you of?

Your first thoughts might well be toward the numerous healthcare related services and projects that are commissioned on a daily basis. A top-level person or body hands some big cash over to a multi-national who sub-contract work to another organisation. They, in turn, pass the work onto a franchise operation within their group which pays a local company of tradesmen to perform a specific task. Done well, with good governance, this can be an efficient and effective way to translate complex national or regional programmes into local actions. But there are risks. One is that cash can needlessly evaporate out of the system at every step. Another is when the person or body commissioning the activities assumes they are being completed to an appropriate standard. They’re blissfully unaware of the harsh reality of unfinished or substandard work.

Involving of chains of people, teams or organisations can end up with systems and ways of working that are costly, over-complex and fail to achieve their well-placed intentions. Take the appraisal-revalidation system for doctors as an example. Few would argue against the ideals. We must maintained standards and strive for improvement. Combining well-planned CPD with reflective learning makes perfect sense as the way to achieve this. Yet too many doctors find the current processes a waste of their time and effort.

Everyday delegation

You may, or you may not, have any influence in such commissioning or national systems. But, even if you don’t, the story of our five hitmen should still make you stop and think. At it’s heart, it is a tale of delegation gone wrong.

How often are tasks delegated to you? How often do you delegate tasks to other people? It happens all the time. It’s essential for continuity of patient care, for general efficiency and effectiveness. All doctors must learn to participate in delegation and learn to do this well. The best approach varies dependent on the abilities and confidence of person you are asking to undertake the work. It also varies dependent on the nature of the task and the reasons for not doing it yourself. Then there’s an additional layer of complexity if the person you are delegating to will in turn delegate onto someone else.

The need for good delegation occurs at the end of every shift, when one team must handover patient care to another. That second team will then handover to another at the end of their shift. When you factor in having a day off, there could easily be five acts of delegation before you are back in contact with your patient. Maybe more.

What lessons about delegation and continuity of care and can you learn from the story of the five hitmen?

Stephen McGuire – Managing Director

End of the specialist era?

The current system of medical education “places disproportionate value on specialism.” These words appear in the foreword to Health Education England’s latest paper on The Future Doctor Programme. And this thought is more than just a throw-away comment. Moving away from over-specialism is central to the proposals HEE have developed through collaboration with other bodies. The fact that our system is predominately staffed by doctors who have gained deep expertise in one area at the expense of breadth is identified as a key reason for its shortcomings. The need to see numerous different specialists, even when conditions are related, “costs patient time and risks fragmented care, duplication and waste.”

So, what’s the proposal?

Step forward The Extensivist and Generalist. I’ve replicated the diagram HEE have used to describe the T-shaped skill-set of this Future Doctor. The idea is that a system where more doctors have both breadth and depth in capability will be genuinely patient-centred rather than disease-centred. Doctors with T-shaped skill-sets are better equipped to manage multi-morbidity. They are more likely to see the big picture, recognise how and why one thing impacts on another and enable holistic management. So, their attention naturally shifts from treating a disease to patient care. Of course, there are still times when such doctors need help. When this is the case, their cross-discipline competence enables them to collaborate with others in a meaningful way.

And there’s more…

The Future Doctors described in the paper have more than breadth and depth in medical expertise. They are multi-faceted and multi-dimensional. They must be able to apply both the natural sciences and social sciences to clinical practice. Our Future Doctors are independent thinkers who are experts in managing uncertainty and ambiguity. They are confident in “resource stewardship… delivering quality care while balancing economic, environmental and social constraints.” The diversity of our population demands expertise in cultural awareness. They must understand the system they work in if they are to be able to optimise services. Leadership, followership and teamwork with the broad range of health and social care providers is essential. They must acquire knowledge about the general principles of scientific research. Then add expectations of excellent communication and teaching skills to the mix. The list goes on.

Many of these requirements are familiar. They are all present either explicitly or implicitly in Good Medical Practice. Yet, reading the lengthy list of “How Must Education and Training Adapt?” statements which appear in HEE’s document, the skill-set expectation of the Future Doctor sounds more like a multi-pointed star model than a simple T-shape.

Is the Future Doctor a realistic goal?

Going back to The Future Doctor Programme’s foreword, there’s recognition that, “For some, it will not go far enough or fast enough, and for others, it will feel like too much too soon.” The latter group may well include the doctors who have aspired to focus on specialism even before starting medical school. It doesn’t mean there will not be specialists. Just that their training and ways of working will be different than they are today. But there are questions over how to create this cohort of doctors who are Extensivists and Generalists.

Is it, for example, realistic for someone to develop the same depth of capability as the current specialist but also have this new desired breadth? How many doctors have the mental capacity to achieve both? Or is this breadth to be gained, to some extent, at the expense of depth? And, while we often think of steep learning curves, what of the “forgetting curve”? If you don’t regularly use what you’ve learned then you’re likely to lose it. After all, you can do anything, but you can’t do everything. So, there’s a risk that a longer time spent on broad-based training before specialism could be a waste of effort.

These are big questions with major implications.

What happens elsewhere?

Many employers in other sectors set out to recruit people with T-shaped skill-sets. But they struggled to find them. Such people can be few and far between, often found in the senior reaches of organisations. They have gained their combination of breadth and depth through many, many years in different roles, often across different organisations and industries. And their efforts at “creating” such people are typically doomed as their lengthy and costly development programmes lose direction. There’s always a high-risk point when the current leaders and sponsors of the programme move on.

But, if the idea of the Extensivist and Generalist approach is the key to efficient, effective, quality care, then these questions and challenges must be resolved. The Future Doctor must become reality. But how?

Sometimes it helps to look at things upside down.

Well, sort of. Rather than think about depth of expertise, let’s think about height. Let’s think about building a pyramid of skill rather than the point of the T drilling downwards. If you are building a pyramid, you will spend a lot of time on the foundations. Each time you begin to add height you will revisit the layers below right down to the foundations to ensure they are solid. You simply can’t imagine adding a new step if there’s nothing there to hold it in place. And you realise that a broad base with well-planned execution creates a more stable peak. Contrast that with trying to win the argument to widen the hole when drilling deeper and deeper downward as fast as possible seems to be bringing rewards.

Pyramid builders

Pyramid scene

Building a pyramid of skill is in itself a multi-faceted task. It requires excellent leadership, teamwork and communication. Planning, prioritisation and constant assessment is essential through robust management skills. It requires experts of many types who are capable teachers and mentors. Building multiple pyramids will require the commitment and co-ordination of everyone involved. So, the pyramid builders must optimise their own skills-set in terms of both breadth and height. The results will be spectacular!

What are you doing to develop yourself to play an active part in creating our Future Doctors?

Stephen McGuire – Managing Director

A new medical interview question

Doctor pondering a tough interview question

The pandemic has been a dramatic collective experience for our society. It’s the type of rare event where the lasting impacts are bound to be far and wide and deep. Healthcare is right at the centre of this, meeting unprecedented challenge with fundamental change. The NHS created field hospitals at surprising speed. Specialists took on unfamiliar roles. Many doctors and other healthcare professionals were trusted with greater responsibility. The need for genuine interdependence with the social care system became more obvious than ever before. Then there was the widespread transition toward digital consultations. I’m sure you can add many other points to this list and that’s before we even start to consider the impact that this has had on you as an individual.

Focus and purpose of a medical interview

Though it may seem like stating the obvious, the task for any interviewer is to find out about you. I’ll explain why this is worth mentioning shortly. They want to uncover your skill levels and development requirements, your attitudes and opinions, your interests and motivations. Rather than pose theoretical scenarios, (which they may well do), the most effective approach is that they probe your real experiences. The more recent, the better. So, with that in mind, a very good question for them to ask is…

What have you learned from the pandemic?

Can you answer that clearly and concisely? Then there are a whole host of underlying and related questions. Tell us about your experience. What challenges did you face? What did you do? Why? What was the impact? What do you now do differently as a result? Can you give us an example of that?

These aren’t really new questions as such. Together, they are simply a good example of an exploratory approach framed in current circumstances that every interviewee should be able to respond to.

Some doctors on our courses expect to be told what to say. But there are no stock answers for these questions. That’s because your individual experience within the global pandemic is unique. In fact, if the purpose of the interview is to find out about you, then there are very few questions where stock answers can be effective. That’s why our approach to medical interview preparation is to help you identify your most relevant experiences, then support you to communicate how they have influenced you to become the person that you are today. We believe that such awareness can open the door for you to become a better doctor. So, pausing to take stock and identify what you have learned from the pandemic is relevant for everyone – even if you’re not about to face an interview. It is likely to be a topic for discussion during your next appraisal or ARCP.

Lifelong learning

The best doctors are able to learn from their experiences. They grow as a result of their difficulties and failures every bit as much as they do from their successes. They identify areas for improvement and proactively take action, rather than simply collecting CPD points because they have to. Having the self-awareness to be able to provide evidence of learning and change will impress any interview panel, appraiser or supervisor and will be driving force for your ongoing development. Proactively revisiting reflective writing skills can open the door to achieving this.

So what have you learned from this pandemic and what are you doing differently as a result?

Stephen McGuire – Managing Director

Why don’t doctors ask each other for help?

A doctor not asking for help

What are the qualities which come to mind when you consider a good doctor? Your immediate thoughts might focus on medical knowledge, clinical expertise and patient communication. Spend a little longer on the question and you might add ability to teach, keep calm in a crisis and good time management to your list. Or, perhaps you came up with a different set of qualities. Now let’s consider a slightly different question.

What qualities do all good doctors have in common, regardless of experience or seniority? Think of doctors in their foundation years, in specialist training, SAS, locums and consultants. Think of the best examples and what they all have in common. Where does “asking for help when required” appear on your list. Does it matter?

Reluctance and the consequences.

In 2018, BMJ Leader published Team interaction for medical leadership, the output of our study into the behaviours of over 200 doctors. We found that 39% of doctors stated that they don’t discuss the support they required to fulfil their role either enough or at all. Participants ranged from FY1 to Medical Director. They included consultants, locums, physicians and surgeons. That’s effectively 2 out of 5 doctors not asking for help when they need it. Again, does that matter?

Failing to ask for help or discuss support required can have serious consequences. Patient safety is the most obvious. But there are consequences for doctors themselves. It can begin with the immediate stress of struggling with a situation. That can affect confidence. Unresolved, this can easily derail a doctor’s career away from an area of interest. Worse still, chronic exposure to stress and isolation are directly implicated in burnout. And there are consequences for teams, departments and organisations too. Failure to identify problems, shortfalls in performance and inefficiency to name a few.

So what’s the root cause?

If reluctance to seek help is the symptom, then diagnosing the reason can help to identify the solution. Unfortunately there are numerous potential causes. And the problem in any one case may be multi-factorial. Let’s consider the issue in three broad categories.

Doctors who don’t think they need help.

We regularly discuss unconscious-incompetence during our various Medical Teaching Skill courses. The inexperienced doctor who is out of their depth without realising it is the most obvious. Any doctor involved in supporting the development of others must be constantly vigilant to this possibility.

But it can easily affect the experts too. When we spend long periods of our time practising with unconscious-competence, our lack of attention and awareness allows bad habits and shortcuts to creep. That’s a step away from returning to unconscious incompetence. Revisiting and refreshing knowledge via Continued Professional Development across the entire scope of practice is therefore essential.

Those who are highly-skilled and knowledgeable with a long sequence of successes can also develop a sense of bravado and hubris. They may not see their errors or even be willing to discuss the possibility. So doctors need to be able to have the tough conversations required to prevent their colleagues joining the ranks of the problematic divas.

Doctors who want help but can’t ask.

Sometimes, a doctor may believe that they can’t get help. This may genuinely be the case. A time-pressured emergency situation arising when the department is over-stretched is one example. But sometimes the lack of available help is only a perception, rather than reality. In our “Team interaction challenges…” study a quarter of the doctors involved reported that they believed their colleagues were unwilling to take on additional tasks to support them. Yet almost every participant said they were willing to help their colleagues.

Practical leadership and management is essential to ensure that the team learns from it’s difficulties, establishes robust support processes and that everyone knows how to get the assistance they require.

Doctors who choose not to ask for help.

Good doctors are appropriately knowledgeable, competent, confident, consistent and reliable. Unfortunately, some interpret the expectations that others have of them, or that they have of themselves, to mean that asking for help is a sign of weakness. In fact, there’s evidence that the opposite is true. People who seek advice in the right circumstances are generally perceived as more competent than those who do not.

Another barrier to seeking help is the expectation of a poor response. A doctor may feel intimidated in approaching a more experienced colleague. “My door is always open if you have a question,” is easy to say. But attitudes and actions speak far louder than these well worn words. Why would anyone approach someone for help if they expect to be dismissed, ridiculed or greeted with irritation?

The way forward.

The days of the infallible, heroic, solitary doctor are long past. In contrast, the demands of modern healthcare mean leaders must strive to develop real teams with a strong sense of interdependence. This is where everyone is willing and actively engaged in supporting each other. This requires an understanding of team dynamics with awareness of each members attitudes, strengths and insecurities – and even the most experienced doctor is willing to ask the most junior for input and ideas.

What are you doing to ensure that you and your colleagues around you are able and willing to ask for help?

Stephen McGuire – Managing Director

Herd immunity to groupthink?

Cartoon image of a herd of animals

When we are debating an issue, loyalty means giving me your honest opinion, whether you think I’ll like it or not. Disagreement, at this state, stimulates me. But once a decision is made, the debate ends. From that point on, loyalty means executing the decision as if it were your own.” So said Colin Powell. He was the four-star U.S. General who became a popular figure to quote for leadership training in the first decade of the 21st century. It makes sense, right? But now sit his words beside those of astronaut Chris Hadfield. “There is no problem so bad that you can’t make it worse!

Hadfield ventured into space three times in his career with NASA. He used this phrase to great effect during a talk he delivered on TED. It’s basically an update on the old adage that, “If you’re in a hole, stop digging!” Unfortunately, “no problem so bad that you can’t make it worse,” is a sentiment which those involved in space exploration have learned at great cost. They have learned from tragedies which have, rightly or wrongly, been blamed on problematic groupthink.

What is groupthink?

People connecting with each other, creating consensus of beliefs, what is right and wrong with positive peer pressure can provide a solid foundation for the development of a community or team. It can create a virtuous circle of improvement, achievement and wellbeing.

However, ‘groupthink’, as defined by Irving Janis, is a problematic mindset where tribal instincts where desire for belonging and expectations of conformity spiral out of control. The ‘echo-chambers’ which can develop in social media are a good example. Participants can become close-minded, hearing what they want to hear, rationalising all information and events as evidence which reinforce their beliefs. They may even reject conflicting facts as ‘fake news’ or a hoax. Members of the group then typically fall into line and avoid rocking the boat rather than question the obvious. A bad problem can get worse and worse as participants become more and more deeply entrenched.

There may well be a broad range of contributing factors. However, groupthink can develop quickly and easily. Our tribal instincts of needing to belong can drive us toward thinking in terms of “them and us” faster than we often realise. Last year, the GMC identified a set of problematic subcultures which exist within the medical profession. Subcultures can grow around divas and/or patronage of certain individuals. Factions develop. Groups of people who feel embattled can collect together, reinforcing each other’s feelings of pressure and hopelessness. Some groups can become insular and detatched, their practices increasingly deviating from accepted standards but are convinced that they are doing the right thing.

Risk points

The problems of groupthink can become greatest when the stakes are highest. It may become acute when time pressures are intense, when there are conflicting demands or when there is a lot to lose. This loss could be physical, emotional, reputation or about resources. Concerns over loss of resources can include time having been wasted, need for unexpected additional time commitment or finances.

We may become closed to new information or fail to speak up when there is a state of urgency. We may not want to hear what we need to hear when the message means having to admit we got it wrong. And we may argue against any idea if it means undoing a great deal of work where we have already invested time and energy – even when tat idea makes perfect sense.

So here’s the flaw in taking Colin Powell’s words at the top of this page out of context. “When we are debating an issue, loyalty means giving me your honest opinion, whether you think I’ll like it or not. Disagreement, at this state, stimulates me.” Such an approach is an excellent groupthink preventer. However, “From that point on, loyalty means executing the decision as if it were your own,” must come with some caveats. Commitment is commendable, but these words can easily be interpreted as, “we will now be resistant to new information.” That would be a dangerous groupthink catalyst.

Developing herd immunity

There is no problem so bad that you can’t make it worse!” Time and the inevitable inquiries will tell if the “herd immunity” approach to dealing with the COVID-19 pandemic was ever the government’s original policy. Was it this approach that made the bad problem worse? Did it have it’s roots in groupthink? Or could it turn out to be the only solution after all? Let’s park that debate and think of herd immunity in a different context.

Herd immunity – where enough members of a community are resistant to something – is an interesting concept to think of in relation to problematic groupthink. If enough members of a team are willing and able to challenge beliefs, point out the issues, listen to inconvenient truths and at the same time stay true to their values then that team will collectively develop an immunity to groupthink. Achieving this requires all members of the team, from most senior to most junior, to develop excellent team communication skills. It is dependent on every member being able to engage in difficult conversations in a constructive manner. People have to be able to speak up if they can see a problem – even after the decision has been made.

What are you doing to help develop herd immunity to groupthink?

Stephen McGuire – Managing Director

Getting the most from video conferencing

Someone falling asleep on a video conference

The pandemic has impacted our lives in dramatic fashion. Some of these many changes will be transient. Others are likely to be fundamental with our perceptions, values and behaviours permanently altered from the previous norms. One notable phenomena is the acceleration of video conferencing across the globe. Families, friends and businesses are keeping in touch via Skype, Zoom, Webex, or any of the other digital platforms which facilitate people getting together. These programmes have been around for a while but have constantly developed and become increasingly effective in recent times through improved internet and WiFi connections.

A change in healthcare

When it comes to healthcare, the most obvious and lasting change may be the shift toward online patient consultations. In the right circumstances, they provide clear benefits to both doctor and patient. They work well for discussion based consultations and for triage. And there can be clear time benefits too. For the patient, a 10 minute visit to a doctor in hospital might represent around three hours away from work. A 10 minute online session on the other hand will take them just over 10 minutes. And for the doctor? If it normally takes an average of one minute for your patient to gather their things, walk to your room then get seated and you’re working on 10-minute appointments. well that represents 10% of the allotted time.

The rise of the video conference

Video conferencing is also now being used for a growing percentage of the other meetings that doctors are involved in. There are progress meetings between trainees and educational supervisors. There are team meetings to maintain and develop everyday working standards. Then there are inter-team project and programme meetings to create new systems and services. Many of these are now taking place online, just as they are in every other sector.

A quick search of the internet reveals all sorts of hilarious video conferencing disasters. You’ll find the toddler marching into the room followed by baby sister then the panicking mother while Dad is being interview on BBC News. There’s the guy who is presentably dressed in jacket and tie – not realising that everyone can see that from the waste down he’s only wearing boxer shorts. And then (oh, dear), there’s the woman who actually goes to the bathroom and everyone can see what she’s doing. Such embarrassing escapades are easily avoidable by engaging even the smallest bit of thinking.

But how do you really get the best out of video conference meetings? It’s useful to consider this from two points:

  • How does this differ from the traditional meeting?
  • How is it the same as the traditional meeting?

So what’s different?

The obvious point is that you’re not in the same room together. So the focus of your attention and the distractions are different. Background noise can be significantly reduced if everyone turns their microphone off unless speaking or directly involved in a discussion. Engagement is always best when everyone has their camera turned on. At very least, it discourages “doing other things” as others can see you.

Most digital conference platforms give you a choice in what you see on your screen. For example, in Zoom, selecting “Speaker view” fills your screen with the person who is speaking. This is a good choice when there is one person talking as you can give them your full attention – just as you would in a normal meeting. “Gallery view”, on the other hand, shows everyone present on screen at the same time. It’s a good choice for dynamic conversation or for the times when you are the key speaker as it helps you’re awareness of the whole group. Controlling and altering the type of view at different times is a good way to keep your focus.

Eye contact is another simple change that can have a significant impact. When we are with people, we spend most time looking at their eyes and mouth. It let’s them know you are interested in them. When you are on a video call you are looking at a screen and the position of your camera will often mean it looks like your gaze is elsewhere. So, make sure you know where your camera is – and look directly into it when you are speaking. It will look like you are looking straight at your listeners.

And what’s the same?

Perhaps the biggest improvements come from recognising there are more similarities to meeting together in one room than there are differences. Acting the way that you would – or at least should – if you were there in person provides good guidance. But that brings up a whole new set of issues because too many “real” meetings are ineffective because the people participating get it wrong too often.

So any meeting, wherever it takes place, will have a better chance of success if:

  • everyone is clear on it’s aim – why is it happening and what should be different as a result
  • everyone has prepared properly – arriving on time with the information they need to hand and with all actions required completed
  • everyone participates in a constructive manner and gives the meeting their full attention
  • everyone is clear and in agreement about what should happen next – who should do what and by when
  • for repeating meetings, the participants regulalry discuss how they are being conducted – what’s going well, what’s not and how they can make things more effective.

If you’re taking part in a video conference meeting from home just do the same things. All you need to add to that list is letting your family members know what you’re doing, go to the toilet before you start and, of course, remember to put on your pants!

Find out about courses running in our Virtual Training Room.

Stephen McGuire – Managing Director