Want to start an epidemic?

It would seem reasonable to think that being responsible for starting an epidemic would be the last thing any doctor would want. We usually consider epidemics in the physical sense. But we also see behavioural epidemics infecting a population. The recent escalation of parents not ensuring their kids are vaccinated is a good example. And we typically think of epidemics in the negative sense. We flip this idea round during our Essentials of Medical Leadership and Management Courses. Being responsible for spreading positive behaviour, ensuring improved working practices take a grip across your team and then beyond is a wonderful thing.

We often know what we want to achieve when it comes to leading quality improvement, championing new techniques or transforming attitudes. But how often do initial changes in team behaviour really stick. How often do initially well received ideas slowly evaporate and fail to take a grip? This happens for a broad range of reasons.

The tipping point

Malcolm Gladwell came to prominence through his book Tipping Point: How Little Things Can Make a Big Difference.  He begins by exploring the factors which contribute to a major outbreak of infectious disease.  He then goes on to look at historical events, cultural phenomena and human behavioural trends. His focus is on how things spread through human populations. Along the way, he aims to identify the key factors which contribute towards the reaching a ‘tipping point’. That’s the point when something moves from being small and contained to a few, to become an outbreak which impacts on the many.  These key forces can be applied to the deliberate spread of ideas and behaviours. They can be utilised to start a positive epidemic.

Gladwell proposed that reaching a tipping point requires three active agents:

  • The right people
  • A fertile context and
  • ‘Stickiness’

The right people

Leadership is often a ‘team sport’. We rarely achieve sustained behavioural change with a group of people on our own via one single act of influence. Change requires maintaining contact with our team members. Shift patterns, busy workloads and people working in different locations are just a few factors which make this challenging. So it helps to involve colleagues who are natural connectors, who are good at networking with people. It’s also useful to involve people with credible expertise who have the ability to distill any complexity or confusion into simple concepts. And support from people who can ‘sell’ an idea, who make it directly relevant to individuals will help ensure that everyone is onboard.

Fertile context

Epidemics require the correct ‘breeding ground’.  An infective agent may have a major impact in one situation.  Yet transferring the same agent to a different time, place or culture may mean that it has no impact at all. Timing is essential. People need to be ready for change. This might mean taking an opportunity as it arises, waiting for the right time or taking steps to ensure your team are going to be receptive to your initiative. As well as there being a ‘right time’ there’s also usually a ‘right place’. These two elements can be guided by understanding the prevailing culture which also informs what is expected, respected and accepted.

Stickiness

You have to genuinely engage people if you want them to follow your ideas. You need them to pay attention to receive your message clearly and unambiguously. So the way that you communicate is important. It needs to be personally relevant to people for them to commit. This works best when they understand ‘why’ and “what’s in it for me or the things I care about” is apparent. But one single instance of relevant engagement rarely has a lasting impact. So follow-up is an essential element of making your message or need for change sticky.

What do you want to change and how will you start your epidemic to make sure your ideas spread?

Stephen McGuire – Managing Director

A perfect recipe for breaking bad news

Healthcare often involves having life-changing discussions. You may need to recommend an unwanted procedure. It could be advising there’s been permanent loss of function. Sometimes you may need to inform that an error has occurred. And, potentially the most challenging, there are conversations about death and dying.

These can be traumatic experiences for all concerned. Traumatic for the patient. Traumatic for the family members or carers . And, of course, traumatic for the doctors themselves. So, it’s little surprise that delegates on our Advanced Patient Communication Skills Courses want to improve their ability to manage these situations and to manage them well. A significant percentage of them are looking for an effective process that they can use. And we do conclude our course by exploring a structured framework which has been proven to help. However, before we think about how to do this, there is a fundamental question to consider.

What do we mean by “breaking bad news well?”

When we delve into this question, there are always a number of doctors with a clear aim. Deep down, what they really want, is to communicate their message in a way that avoids any uncomfortable openly-emotional upset. Desire to prevent unnecessary distress is admirable. But can a lack of emotional disturbance really be considered as a useful indicator of success here?

At Oxford Medical, our definition of good communication is: To ensure that all concerned hear what needs to be heard.

So, an essential element of communicating any type of news is that your message is received and understood. If that message is truly life changing then an emotional reaction should not be surprising. But neither should it be considered inevitable. The initial reaction may well be one of silent shock or questioning denial. Alternatively, it may be calm factual discussion when the message has been heard but the unimaginable full consequences have not yet registered.

And good communication cannot purely be about transmission of a message. You need to be sure that the message has been received and understood. “Hearing what needs to be heard” goes well beyond simple sharing of words. Expressions of emotion are a very powerful form of human communication. They can help you know what message has been heard and understood, what the impact may be and how you should adapt.

It’s likely that you have experienced numerous instances of hearing bad news yourself at various points in your personal life. You may have experienced health issues of your own. You may have lost colleagues, friends and/or family members. Take a moment to think about the reactions you felt in some of these instances.

Process versus comprehension

Chances are, as each set of circumstances was in some way unique, that you experienced a unique range of feelings in response to each event. Patients and their families are no different. They all have unique personalities, unique circumstances and unique relationships with the people around them. So, their reactions are often difficult to predict, sometimes surprising. In fact, approaching the task of breaking bad news with fixed expectations will limit your ability to react to the events as they unfold. The problem with frameworks and processes is that, on their own, they lead to cold, unresponsive communication.

If your role includes regularly delivering life-changing messages then it is likely that these acts of communication will typically be remembered in far greater detail and for much longer by the receiver than by yourself. And they will remember you as a person every bit as much as the message itself. Their memories and emotions are forever interconnected with the way the message was delivered and your reactions to their situation.

Our approach on our courses is to begin by thoroughly exploring the human condition and principles of good communication. What drives our feelings, thoughts and actions. What we need and want. The nuts and bolts of communication. How we react to different circumstances. And we consider this from the aspect of patients, family members and doctors. We then take this deeper understanding and relate it to the various communication models that can be helpful in healthcare.

Comprehension enables intelligent application of frame works or processes. This in turn leads to caring, effective communication with benefits of all concerned.

What steps are you taking to improve you abilities with break bad news?

Stephen McGuire – Managing Director

Sustain the fire, prevent burnout

Hands holding fire

It’s almost two months since the latest wave of medical school graduates joined the NHS. The vast majority are brim full with altruism, idealism and enthusiasm. It’s also highly likely they are feeling significant levels of trepidation. Uncertainty, conscious-incompetence and unfamiliarity can lead to real pressures. And that’s normal for anyone taking up a new role. But there’s an additional problem which is being discussed a lot. The prospect of burnout.

A self-fulfilling prophecy?

If you start to type ‘burnout‘ into your online search-engine and it’s likely to give you ‘burnout nhs‘ as the lead prompt. Medical press, conferences and NHS communications regularly dedicate space and time to the problem. Recently, I had a conversation with a senior doctor who was despairing that the issue seemed to be getting worse. “We’re in a spiral. It must be something we’re doing. It’s becoming almost inevitable.”

Can that be true? Should bright young doctors actually expect to gradually be beaten by constant chronic stress to the point that they become hollowed out, emotionally-blunted, empty shells? Burnout feeds on feelings of self-doubt, inevitable failure and hopelessness. So, is there a risk that both leaders and these junior doctors can be reinforcing a self-fulfilling prophecy which will spread and accelerate the problem?

It’s not just the NHS

We cannot and must not ignore the high prevalence of burnout in young doctors. At the same time, it’s important to recognise that the problem isn’t confined to the NHS. Look out from the UK and we see the issue being discussed by doctors all the way from America to New Zealand and around the globe. Nor is it limited to doctors or even healthcare. Some commentators are, rightly or wrongly, labeling millenials as being the ‘burnout generation‘.

Feelings of isolation are further drivers/symptoms of the burnout spiral. It therefore makes sense that, at the same time as looking at the specific experience of being a doctor,we pay attention to discussions away from the medical arena. So what’s the way forward?

Prevention is better than cure

Burnout is the reaction to chronic stress. But what causes stress to one person can be somethings that others have learned to take in their stride. The requirements for junior doctors to learn cause, diagnosis and treatment of disease and how to interact with patients are obvious. But we must also remember that the earlier that they learn good coping mechanisms, the more likely we are to retain beliefs, energy and enthusiasm. So dedicated efforts to gain planning/organisation skills, the ability to have difficult conversations with colleagues and understand the UK healthcare system are also essential.

Leaders have a responsibility to encourage and facilitate such development. In addition, this quote should provide some nourishing food for thought:

What we call burnout, that sense of despair, hopelessness and loss of joy is not due to a failure of the individual. It is a failure of the environment they work in, the culture of the workplace, the workload imposed on this.

Professor Andrew Goddard, RCP president

Leaders have a duty of care for those who work for them. So, it follows that leaders also have a duty to develop their own abilities in creating real teams, becoming more organised, addressing bullying and the problematic subcultures and delivering change via positive behaviours.

What steps are you taking to sustain the fire and prevent burnout?

Stephen McGuire – Managing Director

It’s official. We’re Excellent!

Excellent rating from TrustPilot

We’re delighted to see that TrustPilot now rate us as Excellent. That’s based on a total of 849 reviews from doctors who have used our CPD accredited courses over the past few years.

We invite every single doctor who attends one of our courses to post a review if they wish. They don’t have to. So we’d like to thank each and every doctor who chose to take the time to write a review and make your thoughts public.

All of these comments are available unedited and publicly visible and we respond to each and every one. So you won’t just see the numerous excellent five-star ratings that make us so proud. No-one is perfect. The good, the occasionally bad and the rare ugly comments are out there in the open for all to see.

The value of feedback

We build the topic of feedback into many of our courses. It’s a fundamental element of good team-communication. It’s essential for teaching, leadership and management alike. So we regularly explore the need for doctors to talk to each other about their concerns, the impact that actions have had on them or others and what needs to change. They also need to reinforce what is going well. And this cannot simply be limited to annual, anonymous, digital form filling. There needs to be conversation. Unfortunately, there is plenty evidence that there are major shortfalls across the medical profession in this respect, which is why feedback is a regular topic for my blog posts.

We don’t just rely on our TrustPilot reviews. We also ask every delegate to provide us with written feedback at the end of each course. This let’s us identify what we’re doing well. That let’s us spread best practice across our Faculty of Tutors. It also let’s us know where we’ve fallen short, what’s got in the way of our learner’s progress and what else our doctors would like. That means we can continually address issues and build on our strengths.

Openness

The importance of privacy and confidentiality is regularly discussed in relation to feedback. However, the TrustPilot website reviews go beyond regular feedback as the comments are out in public. That’s our choice. Such openness provides added incentive for us to tackle issues as and when they arise. The reviews also help us to celebrate our successes. The desire for improving our trends and our overall rating gives us motivational targets to aim for.

There are some similarities here to the public ratings which providers receive from healthcare regulators, such as CQC. It’s all too easy to feel under attack and disagree with some reviewers opinions when a poor rating is received.

How effectively are you channeling feedback, reviews and ratings into performance improvement?

Stephen McGuire – Managing Director

Ready Doctor? Er… No!

Wait! Traffic lights on amber

New junior doctors feel unprepared for work. That’s the stark headline in HSJ where they report on an interview with Professor Wendy Reid, Medical Director and Executive Director of Education, Health Education England. Dr Reid goes on to describe the problems being encountered by new doctors as they leave medical school and take up their first roles in hospital.

It’s more than just finding themselves in a new hospital environment. It’s more than finding themselves working with new people they have never met before. It goes well beyond just moving to a new town or city away from family and friends – and that’s a major life transition if ever there was one. Professor Reid is making a point about how well medical schools are preparing students to actually work as doctors.

But let’s concentrate on the human aspects of the new doctors’ experience. Let’s consider the culture they discover when they arrive in their new placement.

Problematic subcultures

The General Medical Council recently published a report titled, “How doctors in senior leadership roles establish and maintain a positive patient-centred culture.” This document describes five problematic subcultures which exist in many areas of the NHS. It includes:

  • Diva subcultures where self-centred dominant people are allowed to get away with inappropriate behaviour while everyone else make adjustments to avoid confrontation.
  • Factional subcultures where mismanagement of disagreements lead to people choosing sides and organising themselves around the conflict.
  • Patronage subcultures where there is reluctance to challenge highly respected, well-liked and/or supportive individuals through dependence or loyalty.
  • Embattled subcultures where the constant pressures have led to collective feelings of being under attack and/or hopelessness.
  • Insular subcultures where people have become isolated from the mainstream, either geographically or psychologically, leading to deviations from accepted standards.

Any of those sound familiar? It’s worth thinking of this list as a Venn Diagram because it’s not unusual to find more than one of these subcultures existing within one single group of people.

Now pause and think. What impact are these subcultures having on the latest cohort of new junior doctors? In the short term, will they simply join in and participate in these problem groups? Long term, what will they “learn” from experiencing bad examples? Some of them may recognise this is not how things should be and take positive action. Unfortunately, many may simply learn how to become part of the problems. If this is the case, then the subcultures will not only persist. They will grow. The cycle goes on. Year after year after year.

Breaking the cycle

Let’s return to that HSJ interview with Professor Reid. “Positive investment [in education] and training is how you get the workforce you need.” “It’s not just about recruiting more medics but also how they can be used differently in the system.”

Healthcare workforce education and training has to go beyond the natural sciences and technical sciences. There is a wealth of social scientific development which has great benefit to patients, workforce and organisations alike.

There’s a popular drive toward development of leadership skills for doctors. This should be applauded. But are we developing people to lead individuals or to lead teams? If the toxic subcultures are to be addressed, then there’s a need for both. Leading people requires you to develop clear understanding of them as individuals. Leading teams requires you to develop clear understanding of team dynamics.

You have to learn the differences between healthy teams and dysfunctional teams. You have to learn how teams develop and why they can go wrong. And you have to learn how to resolve problems when they occur.

The best leaders don’t just strive to develop both their individuals and their teams. They recognise that they are not alone. So, they recognise they must form and participate in leadership teams. Team communication skills are therefore a fundamental building block of great leadership skills.

Healthy Teams in Healthcare

We recognise the specific challenges of this time of year. So, we’re making our one-hour online course Healthy Teams In Healthcare available free of charge until 15th September 2019. Simply click here, add the course to your basket and use the following coupon code to reduce the price to zero.

hth2019

The course is accredited for 1 CPD point. Feel free to share this with your friends and colleagues. It’s relevant for every grade and level of experience. It’s also well worth discussing what you learn as a team.

What steps are you taking to develop your team communication skills?

Stephen McGuire – Managing Director

How to make something invisible

Someone invisible through camouflage

Think about your most recent journey to work. You might have driven, used public transport or walked. From the moment we left our front doors until we said hello to our colleagues our individual journeys will, in many ways, have been unique. But we all have at least one thing in common. We were constantly being bombarded with information.

There were information signs, warning signs and advertisements. There were words, symbols and pictures. Bleeps, bells and dimpled paving stones. But how many did you pay attention to?

There are two main points to consider here and they have direct relevance to leadership and management.

Overload and familiarity

The first problem is that there’s just too much information around. If we all took the time to read or interpret everything available then we would grind to a halt. We can’t possibly pay attention to everything. So, we have to be selective. And that’s where the second problem comes in – familiarity. Why should we pay attention to anything we’ve seen repeatedly again and again and unchanged when there’s so much information vying for our attention?

Quite simply, the easiest way to make something invisible is to leave it unchanged.

We have a sign on the door of our office which says, “Please check that all windows are closed before leaving.” We put it there as a reminder after forgetting twice within a two week period. But, two years on, how often does anyone take any notice of it now? Well, the recent early morning incident with the pigeon should be a clue…

Have a look at any notice board in your workplace. How long have the various posters and messages been there? How many are still relevant? Are any of them out of date? And how many of them would you have noticed if you hadn’t made the conscious decision to go and look at them.

An issue for leadership

How clearly and explicitly do you feel your teams goals are defined? When we asked over 200 doctors this question 21% of them responded either “Not at all” or “Not enough”. Our study was published in BMJ Leader. You might be puzzled by that response. After all, aren’t the team goals clearly defined on the notice board?

We also asked the same participants, “How effectively do you discuss progress towards these goals with your fellow team members?” In this case, 40% responded either “Not at all” or “Not enough”.

What are the chances of success if one fifth of a team are unsure what they are trying to achieve and two fifths are unsure if they are making progress or not? And how well are all those new team members who are joining fresh from medical school or latest training rotations being briefed? What about the locums who are covering holidays?

Learning from advertising

The numerous marketeers who place advertisements on radio, billboards and television are experts in grabbing our attention. They know all about invisibility phenomenon. So they change things regularly. They make sure that we are exposed to their message in different ways, in different places and at different times. And they make sure that we see, hear and feel their message in a manner that that is relevant to us.

What are you trying to change or achieve?

How visible or invisible are your goals to your team?

Stephen McGuire – Managing Director

A steep ‘forgetting’ curve?

There are likely to be a lot of unfamiliar new faces around you at the moment. FY1’s are taking their first steps after completing Medical School. FY2’s are starting their next rotations. The latest recruits are beginning their various specialist and core training programmes. And it won’t be long before the newest batch of university students turn up. We’ll often say that they are on a steep learning curve. But, if you are involved in supporting their development, whether formally or informally, then there’s another important question to consider.

How steep is their forgetting curve?

It happens to us all. You’re a qualified doctor. So, you must have passed your university exams in a broad range of subjects. How well would you get on if you were to re-take these exams today? Would you pass with flying colours as you once did? Or would there be fundamental gaps in your knowledge or skills?

Our initial learning curve is quickly followed by a forgetting curve. This was described by Hermann Ebbinghaus way back in the 1880s. He even proposed algorithms to describe the curve’s decay rate.

We see this forgetting curve played out over short time-scales with regular frequency during our Teach the Teacher Courses. Our delegates each have several opportunities to practise teaching their fellow delegates. So they also have numerous experiences of being taught, learning new skills or new information. It can be remarkable to see what they manage to achieve in just 10 minutes. And it can be surprising how little they have retained just half an hour later.

Optimise learning. Minimise forgetting.

Without doubt, there’s a lot to be learned. So, you have a lot to teach. All too often, this means we go too fast. We try to ‘maximise’ learning, to get as much done as quickly as possible.

Let’s consider the idea of “See one. Do one. Teach one.” It’s a fairly common phrase in the medical world. But is it really a good recipe for the consistent transfer of skills? The forgetting curve means the output of this approach is more likely to be, “See one. Do one. Forget one.” Even worse, it could turn out to be, “See one. Do one. Teach something that isn’t actually correct.” And the consequences of that should immediately set alarm bells ringing.

Clearly, the learner has a significant responsibility here. The teacher can’t actually do the learning for them. But, at the same time, the teacher’s approach can make a significant difference.

Think of the last time you were teaching someone something. How would you describe the balance of your focus in the following two domains:

  1. Acquiring knowledge or skill
  2. Retaining the knowledge or skill

We’re wasting our time if what we teach isn’t going to be retained. So, it makes more sense to try to ‘optimise’, rather than rushing to ‘maximise’ learning. At the same time, it’s important to take steps to minimise forgetting. A well judged pace for initial acquisition, combined with an appropriate degree of repetition and assessment over a period of time is always going to be more effective than “See one. Do one.”

But you might think, “Doesn’t this idea of minimising forgetting sound negative?”

A positive alternative

Understanding the realities and reasons for the forgetting curve helps to clarify the issue. The positive alternative to ‘minimise forgetting’ is to ‘maximise retention’. Focus on pace, repetition and assessment is just one consideration in achieving this. A teacher whose approach is firmly grounded in all the theories of adult learning will aim to facilitate efficient acquisition and help to maximise retention.

What steps are you taking to manage both learning and forgetting curves of the doctors you are supporting?

Stephen McGuire – Managing Director

What are your weaknesses, doctor?

Arrow in the heel

Theresa May has resigned. So, senior members of the Conservative Party are currently vying to be the person to replace her as both party leader and Prime Minister, (though nothing is certain in the current world of UK politics!). As they attend the various hustings and debates, they are basically being subjected to a prolonged and very public job interview.

During one televised leadership debate, the candidates were asked a classic interview question by a member of the audience. Can you describe what you greatest weakness would be?

Who gave the best answer?

Well Boris Johnson didn’t take part in the debate. Tip #1: always turn up for your interview!

Of the five candidates who took part, three of them chose to avoid any suggestion of weakness. They took the “let me show you how strong I am” approach. Michael Gove emphatically stated “I’m a man in a hurry” to get things done. Dominic Raab took a similar line abut being restless for change. Sajid Javid and Jeremy Hunt talked about stubbornly sticking to their opinions.

But are these really weaknesses in a leader? Possibly. But aren’t committing to opinions and wanting to get things done quickly positive attributes if used the right way? Perhaps we shouldn’t be surprised when Politicians turn a question on it’s head to suit their purpose?

Ignoring any political preferences, the answer from Rory Stewart took a very different approach. “I don’t know where to start. I’ve got a lot of weaknesses.” He went on to talk about being human. He used words like “frail” and said that, from the life he has led, there’s so much that he doesn’t know or understand about the world. That sounds like a more genuine answer. But do the interview panel want to hear that you are not up to the job?

What are interviewers looking for?

Your interviewers want to find out as much as they can about you as an individual and if you are a good match for the job in hand. They want to know about your experiences, your opinions, your disposition and your attitude. They want to know about your successes and your failures and how you deal with them. You are unique. So, model answers simply don’t work.

Many interviewers have moved away from the standard “What are your strengths” question. It typically results in a very rehearsed response. So, they are more likely to look for proof of your positive attributes by exploring specific examples of your experiences. Directly asking “What are your weaknesses” is probably more common than the strengths question these days.

They ask this question for a few reasons. First, they want to uncover your levels of self-awareness. You aren’t perfect. So how honest are you with yourself? Next, they want to check your awareness of the role you will take on. What do you expect to find difficult if you get the job?

The best way to answer?

Thorough preparation is essential for any interview. Our approach to interview preparation is to guide you through a detailed review of your experiences as the method to identify strengths and weaknesses. Our recommendation is to confidently share the things that you find difficult or where you may have gaps in your experience. But it’s the next point which can make the biggest impression on your interviewers.

At very least, you must be able to describe how you will ensure you perform well in the role and manage any shortfalls. Even better, you will impress if you can describe proactive steps you have already taken.

For example, if you identify that it would help to explore different leadership styles then it makes sense to do something about that. Alternatively you may benefit from learning a more structured approach to managing change. Or, if the role you are seeking involves guiding less experienced doctors then developing your mentoring skills would make sense.

What do you need to work on to perform at your best?

Stephen McGuire – Managing Director

Harder realities of ‘soft-skills’ failures

Images of clouds

How important are ‘soft-skills’ for doctors?

Well, there’s general consensus across meetings, conferences and the medical press that the answer is obvious. So let’s ask a different question.

What priority is being given to genuinely improving ‘soft-skills’?

It’s a question worth considering as numerous media reports have a ‘Groundhog-Day-oh-no-not-again!’ feeling about them. We’ve had bullying in the Highlands, a persistent culture of abuse at Whorlton Hall and a study where 74% of medical student reported experiencing ‘teaching by intimidation‘.

Clearly, major transgressions by the key perpetrators are central to these cases. But such events are often compounded by ‘soft-skills’ failures from their leaders and colleagues. For a variety of reasons, when witnessing problematic behaviour, doctors are failing to take effective action. Many don’t even attempt to intervene. Perhaps they feel intimidated by a difficult personality. Perhaps they don’t know how to have the difficult conversations. In some cases, the perpetrators are simply repeating behaviours which are entrenched in the culture. So, it just seems ‘normal’.

Impacts of the failures

The direct impacts of bullying and intimidation of NHS staff members are well documented. Stress, absence and burnout are all too common. Occasionally, such negative experiences can have tragic consequences. The alarm bells ring loudly each time to flag that something must change. Again. And again.

But look further and there is a growing body of evidence of further impact.

If you are a regular reader of Oxford Medical’s Insights then even the title of this blog you are reading might give the Groundhog-Day feeling. In August last year, we shared Hard realities of ‘soft-skills’ failures by doctors. In that piece, we were commenting on the conclusion that ‘toxic bickering’ between groups of doctors led directly to an increased rate of patient deaths from cardiac surgery at St George’s Hospital, London. Poor leadership had compounded the original dysfunctional behaviour.

An isolated case?

Was St George’s an isolated case? Unfortunately, no. The Groundhog-Day feeling was there again last week with news of problems at Morcambe Bay UHT’s urology services. Dysfunctional team behaviour and bullying were directly implicated in a patient’s death. BMJ reported:

The RCS found “a lack of coordinated team approach to delivery of care and unclear lines of consultant responsibility” and, as these issues had not been resolved, a similar incident could occur again. Disagreements in how to treat patients had resulted in consultants refusing to assist one another.”

Exceptional cases?

It’s easy to dismiss these events as being down to a few bad apples. A few underperforming doctors can have a major impact. Yet, on our various courses, our delegates regularly share real experiences where team communication problems have had direct impacts on patient care and staff wellbeing. In addition, our research reveals that many doctors struggle with basic team interaction skills. That’s from their own self-assessment.

That suggests the high profile incidents mentioned are simply the thick end of the wedge.

‘Soft-skills’ can be tough

In our previous blog, mentioned earlier, we questioned if the ‘soft-skills’ label was part of the problem. It sounds a bit nebulous. And how much impact can you have with something that is ‘soft’? Maybe it’s for people who don’t have ‘the right stuff’. But the hard reality is that applying ‘soft-skills’ can be really tough.

It typically takes the bravery and determination of a lone whistle-blower to bring the extreme cases to wider attention. These doctors prioritise doing the right thing over personal concerns or even risk to their career. We commend them for their actions. Once again though, this is at the extreme end of the issue.

For successful, everyday practise, doctors must have a sound knowledge regarding how and why individuals develop into teams. They should also understand how and why teams go wrong and how to effectively deal with issues. They must be capable of getting things done without reverting to bullying or intimidation. The abilities to deal with differences, conflict and to have those difficult conversations when the going gets tough is as important as any other skill. Such skills must be learned, improved and utilised to shape a constructive culture.

Our conversations with organisations indicate they are slowly waking up to the need for doctors to be equipped with these skills. (Their motivation may, in part, be self-protection as patient care as failures can lead to litigation). And doctors must recognise that attention to these abilities is essential for continued professional development and team performance. Good Medical Practice makes this very clear. It’s the only way to break free from the Groundhog-Day cycle.

What steps are you taking to develop your ‘soft-skills’?

Stephen McGuire – Director of Development

The rumble of the grumble

We’ve all been there. We’re driving along. Maybe we are tired. Maybe something distracts us. Maybe we’re taking a bit of a risk. R-U-M-B-L-E!!!

You may be one of the countless people who owe their lives to an incredibly simple invention. The rumble-strip. I know that I am. A sudden noise and vibration alerts us to imminent danger. It jolts us back to attention and we take immediate action. We live to tell the tale. Or maybe we’d prefer not to tell anyone. Either way, disaster is averted and we learn our lesson.

“Rumble-strips” in healthcare

There are many equivalents to the rumble-strip in healthcare. Lights flash. Beeps change. Tools and communication devices vibrate. They send and endless array of signals and messages. What do they have in common? Well, most obvious is that they all typically indicate something has changed and action is required. But it’s also worth noting these examples are all patient-focused.

Clearly, we want patient safety. But what about the safety and well-being of the people who deliver the care? What about the doctors, nurses, managers and other professionals you work with? After all, burnout and breakdowns are all too common. When do we notice when things start to go wrong with healthcare workers? All too often, breakdowns and burnout are only noticed when things go badly wrong. It’s too late to take action. And when people breakdown and burnout it can be permanent. So where are the rumble-strips to alert us to those issues?

Could it be that grumbling is the rumbling that should grab our attention? Well, yes – and no!

Grumbling

A grumpy cat

It’s normal to grumble. In fact, psychologists believe that a bit of a grumble is good for us.

Sometimes it is just a safety valve. We need to let off steam about the things that frustrate us. This is particularly true when things are beyond our control. A good old grumble let’s us get it out of our system and move on. It also has a role in building and maintaining relationships. Sharing thoughts, feelings and opinions with others is an act of trust. It’s also a normal human approach to finding common ground with others. Common ground and trust helps us to form teams. Best of all, talking about our frustrations can be the first step in making something happen. It can be a catalyst for change.

So the grumble itself isn’t the danger signal rumble-strip noise.

Changing rumble of the grumble

Some roads we drive on are much noisier than others. But the humble rumble-strip even works on the noisiest roads. That’s because it alerts us to change by providing change. The sound changes. The feeling of the steering wheel changes. This same ‘alert-to-change by providing change’ idea is true of the various vibrations, bleeps and flashes mentioned earlier. The regular grumbles of the healthcare workplace are akin to the background noise on a very rough road. It’s change in the noise that should make us sit up and pay attention.

We make good use of a 5-aspect model of resilience on a number of our courses. Basically, we are at our strongest when we are positive, focused, flexible, organised and proactive. So, any negative change in any of these elements can be the early warning rumble that someone is struggling. And for resilient teams we need to consider both ourselves and those work with.

A few questions

Have you noticed any of the following changes in either in yourself or any of your colleagues recently?

  • An increase in negativity or general grumbling?
  • Grumbling about things at the ‘wrong time’? For example, grumbling to a patient.
  • Grumbling becoming increasingly fixated on one particular thing?
  • An increase in resistance to change or willingness to adapt?
  • A decline in levels of organisation, punctuality or complaining about ways of working?
  • An increase in negative reactionary behaviour or expressing lack of autonomy?

As mentioned, each and every one of us will have a good old grumble from time to time. It’s the changes in frequency, intensity or duration which should grab our attention. They can be the equivalents of the rumble-strips which have saved countless lives and careers through the years.

Finally, we must also look out for the change which is one of the most powerful, yet easily missed alarm signals of all. Silence.

Have noticed a change in anyone’s grumble levels recently?

Stephen McGuire – Director of Development