How political should a doctor be?

Doctors have been more visible on the UK’s political stage over the past year than ever before. We have all regularly tuned in to broadcasts with Chris Whitty and Jonathan Van Tam in the full glare of the television spotlight. News media carried endless reports of challenging conversations taking place behind closed doors. Meanwhile, various members of SAGE have popped up across a whole range of topical discussion programmes. Senior healthcare leaders have played an essential role in addressing the pandemic. But, as we slowly return to normality, just how political should a doctor be?

What do we mean by “political”?

When we think of politics, it’s easy to think of the big parliamentary parties. They are all about to enter the annual pantomime phase of their conference season. In an ideal world, this would be where their various members gather together to debate the big issues of the day, reach a consensus and define policies for the way ahead. Sadly, these meetings have typically become major stage-managed events. Speakers aim to deliver headline-grabbing soundbites which are more for the general public than discussion with the audience in the hall. They’ve become forums for publicity rather than debate. In keeping with the general population, involvement in such events is probably only for those doctors who feel strong allegiance to one of these parties.

But let’s consider “politics” in the broader sense. Consider it as the set of activities associated with decision making where individuals or groups have different interests. These decisions relate to defining priorities, timelines, ways of working, distribution of resources and much, much more. In that sense, we all have political interests.

Political hot topics for doctors

Scanning current general news media reveals a broad range of topics affecting doctors. Digging into the medical press then brings these issues into sharper focus. There are numerous decisions to be made. Inevitably, some are more emotive or tangible than others.

Take, for example, the case of tobacco giant Philip Morris International who are currently trying to buy a pharmaceutical company who make inhalers for £1.1bn. Is it ok that we could have a huge organisation making massive profits from both selling the products which inflict harm and treatments for the resulting disease? is it ok that the NHS will end up paying a tobacco company for treatment. Many readers will hope our Government intervene in some way. Yet this may feel like an issue that is a bit distant from your daily practice. It’s an emotive situation, but for high-level decision makers to deal with.

Potentially much closer to home is fact that the BMA has recently adopted a neutral stance to assisted dying. It’s a big shift in position and one that’s been made to reflect the differing opinions of its members. Legislative change here could have a huge impact for you, your patients and their carers. Alternatively, you may feel the current status quo is unacceptable. So, you may want to make sure your voice is heard in that debate.

Then, there’s our challenge of finding a way out of the pandemic to a new normal. How will we re-organise our systems and make good use of the recent increase in funding? How will healthcare and social-care actually integrate? Who will make these decisions? This requires decisions at every level, from the top of Government to the teams you work with. So who will make them? How can you realistically become involved in shaping the future?

Getting involved

The start point is to be well informed, then stay informed and up to date. Next, it’s about recognising how and where you can make a difference.

In simple terms, our NHS and social care systems are made up of groups of people who serve groups of people. Each of these groups are made up of individuals. Decision makers need to hear opinions and ideas from the individuals involved and people affected. So, we all need to ensure our voices are heard in the right way at the right time by the right people. You may not get your own way, but at least you will have tried. Better that than being a passive passenger, swept along and at risk of finding yourself adrift. At the end of the day, that’s politics.

What are you doing to ensure you are informed and that you voice is heard?

Stephen McGuire – Managing Director

Why bother with organisation values?

UK health and social care organisations now all typically boast their own defined set of values. They proudly list them on their websites, stationary and notice boards. Leaders refer to them during presentations, in newsletters and other communications. They tell us how good and caring these organisations are. But now consider them against the backdrop of numerous news stories, independent reports and the daily reality of being an employee or patient. Bullying; sexism; burnout; problematic sub-cultures; patient complaints. Take your pick from these issues, and more, because they all make regular appearances in these blog posts and beyond. David Oliver makes some very good points in his recent column in the BMJ: “When organisations’ behaviours betray their value statements.

The problem with organisational values

As human beings, we each develop our own unique moral code and guiding principles. They are informed by our personal life-experiences and beliefs. For some of us, this might not go much further than experiencing a simple gut feeling or niggling voice in the back of our minds when things aren’t right. For others, who have taken the time to consider the matter, this could be a set of written values. In the best cases, these are consciously used to inform decisions or to review actions. But we are all unique.

Organisations and teams benefit in many ways when members commit to common ideas. So the obvious step toward improvement is to define values as guiding principles and communicate expectations. If we know what we want to be then we can check our behaviours against this. We can also hold each other accountable and celebrate what we do well. These are fundamental elements of functioning as an effective team. It sounds like it should be straightforward – but how do you take the individual nuances in beliefs of numerous people and create something that is meaningful to everyone?

The reality is that we often end up with words which are a weak dilution of anything meaningful. David Oliver describes how these value statements often end up as “generic platitudes that no one could disagree with as principles.” “We act with dignity”; “are collaborative”; “inclusive compassionate” and “based on individual needs.” But, given the challenges and constraints which employees face on a daily basis, are these expectations realistic ? And what’s the point of spending time defining values if behaviour that’s at odds with the stated principles regularly goes unchallenged? In addition, each and every one of us can interpret the same set of words in our own personal way.

So are values statements a waste of time?

Well, if organisations create them to tick a box, or if people don’t even try to live up to them, then the answer has to be “yes”. But David Oliver’s closing paragraphs point the direction toward making them well worthwhile:

I’d challenge all readers—myself included—to go back to the organisations or health economies they work in, look at their value statements, look at the NHS constitution, and ask themselves, “Do we even believe in what we’ve signed up to? How much of this do we really live up to in practice? And how could we get a bit closer to delivering on it?”

David Oliver – BMJ, September 2021

And it’s that last question which is perhaps the most important one. None of us are perfect. When we each define our personal values, they are aspirational. They are what we want to be now, and in the future, regardless of the challenges we face. When we fall short, we remind ourselves of this and take steps to redress or do better in future. In this respect, organisation or team values are no different.

When well-considered, well-written and utilised, they are effectively goals which tell us what we want to be and provide direction. They should be used to inform decisions, to challenge and to hold each other accountable – even if they are inevitably generic to some extent.

How do you use your team and organisation’s values on a daily basis?

Stephen McGuire – Managing Director

Imposition or investment?

“A big political moment.” That’s how the BBC’s Laura Kuenssberg described the lead up to the recent announcements about changes to funding the NHS and social care. The systems are now being given a significant headline grabbing cash boost. Considering the scale of challenges we are facing, there are very few voices who oppose that. But public systems are ultimately paid for by taxes and decisions related to our tax system always divide opinion. Yes, we should all pay our fair share. But, when it comes down to it, what’s fair?

The complexities of public funding

Income tax, National Insurance, VAT and Capital Gains are just a few of the methods our government uses to collect cash to spend. As an NHS doctor, the fact that you pay into the public purse and, at the same time, are paid by it can heighten the conflicting emotions connected to these questions. It feels great when you and your colleagues are awarded a salary increase you deserve. But you then find you are to be taxed more in order to fund NHS pay-rises and additional staff, along with improved facilities and treatments. At the same time, you may see cuts to other public services which you care about and want more to be done in those areas.

Big questions

Our democratic model means we empower our government to make decisions on our behalf. That’s fine when things go the way we want them to. On the other hand, it can be infuriating if and when our collectively elected representatives hold different views to your own. Ultimately, regardless of political persuasion, we have to answer some big questions. For example:

  • How much are we willing to spend on our public services in general?
  • How much of that do we want to spend on health and social care?
  • What’s the balance between each person paying for our individual needs versus supporting our relatives, friends and neighbours?
  • Should we all contribute the same or should those who can afford it pay more?
  • How do you work out who can afford what?
  • If there’s a limit to what we can or are willing to contribute, then what do we spend less on if we want to spend more on health and social care?

And then there’s perhaps the biggest question on this subject of all. Are taxes an imposition or an investment?

Having an impact

Like many things in life, making decisions about taxation, public spending and government policy related to accessing services is likely to be beyond your control. But that’s not to say that you have no influence beyond your occasional opportunity to cast your vote. Your opinion matters. Everyone’s does. But, as a doctor, your opinion can count for more. People will take heed of your opinion as long as it is informed, considered and aligned with your everyday actions. A society’s collective opinion is shaped by individuals.

If you are to be a proactive participant, then it’s important that you have a good grasp on who’s who in terms of the various organisations which collectively make up the health and social care systems. You will understand how the money flows in a general and be aware of the conflicting demands which come into play. You will be able to engage in discussions around topics such as the pros and cons of big surgical hubs versus providing access to care which is close to a patient’s home. And you will be able to not only recognise waste or inconsistency, but to work with others to address this. Influence and genuine change comes around through numerous moments of everyday medical leadership.

What steps are you taking to learn about the system and the part which you can play in it?

Stephen McGuire – Managing Director

New teams, new faces, new places?

It’s that time of year again. The sun is shining; the flowers are flowering – and, all across the UK, teams of doctors are in a state of flux. You may be fresh from university and taking up your first post. You may be moving to join a new team in a new location to start your next rotation. Or you may be settled in your role but surrounded by new faces. It’s an annual ritual and a challenging experience for all concerned. But the past couple of years have been unique in countless ways. So, will this August and the following months be a fresh start? Or will they be just another iteration of the cycle where age old problems are repeated?

The same old problems?

The normal stresses and strains for doctors have been dramatically amplified by the pandemic. Unfortunately, stresses and strains affect our moods, behaviours and our communication. Our behaviours and communications then have direct impact on the people around us. In any given year, you never have to look far to find the latest reports about bullying, toxic bickering or burnout in the medical professions. So, should we expect more of the same? Should we expect worse? Or do the changes to teams, faces and places create opportunity to break this cycle?

It’s worth pausing to consider a key message from Dame Clare Marx’s recent resignation letter from her post as Chair of the General Medical Council.

“When I look back on my career, I remember how I was treated. In my happiest moments, I felt respected, valued and listened to. I felt I belonged.

In a service short on time and short on resource, there is no excuse for being short on kindness and politeness. We are in control of how we treat each other. Our behaviours determine the success of our working relationships, with both colleagues and patients.”

Dame Clare Marx, Chair of the General Medical Council

The big question is, how to break free from the past and make this fresh start?

The solution?

As human beings, communication is at the heart of everything we do. Whether good or bad, it defines our social experience, our identity in the eyes of others and often makes the difference between success and failure. Good communication is also a fundamental ingredient for developing a successful team. So, we can’t afford to let it be taken for granted. Regularly taking a pause to reflect with fresh input is as essential for this skill as it is for any other clinical knowledge or abilities.

What are you doing to improve your team communication skills?

Stephen McGuire – Managing Director

What to do about the ever-changing team?

It’s fairly common for teams of doctors to be in an almost constant state of flux. It won’t be long before the next cohort of students leave university and join the workforce. That coincides with the regular rotations for doctors in training. Summer also (hopefully) means time off for holidays. Then there are vacancies created by ongoing career progression movements. Any temporary gaps created are filled by locums, who may be with your team for days, weeks or months.

These changes create challenges for both the doctors taking up new posts and the teams they are joining. There’s a lot to learn, meaning it typically takes time for new personnel to get up to speed. So, efficiency drops. Then there’s the question, “How do I trust people I don’t know?” It’s a stressful time for all concerned. Experiencing this again and again can feel like you are going round in circles. It’s hard enough trying to maintain standards and performance. Even harder making improvements. In fact, such constant transition risks creating a downward spiral if you don’t manage it properly.

Increased stability may seem desirable. However, these regular transitions are the reality of our system. So, the question is, how to turn these interruptions to our advantage?

Preparing for team changes

First of all, it helps to acknowledge the fact that none of this is easy. Giving someone a well structured welcome to your team takes dedicated effort and time. You know it’s important, but there are many conflicting demands. So, it can be tempting and quicker to simply do a task yourself. That’s easier than taking time to provide the information or support for the new joiner. But that means you’re working harder and under even more pressure. In addition, they will take longer to get up to speed and to play an active role. Everyone benefits if you learn how to prioritise and to delegate well. These fundamental skills help you make decisions – what to do yourself and what to pass on? – and ensure you make your choice for the right reasons.

An opportunity mindset

Next, it’s useful to adopt a mindset where you see both leavers and joiners as opportunities. At the very least, it’s your opportunity to ensure you do it better than the last time someone joined or left!

With the person leaving, you can review their experience in the team through honest conversation. What do we do well? Where do we need to improve? What should we stop, start and continue? Listening to their opinions is likely to help you clarify where you need to focus your energies.

Now, let’s turn our attention to the person joining your team. Consider what they need to become an effective team member. We explore this on both our Essentials of Medical Leadership & Management and our Advanced Team Communication Skills courses. What information do they need? What resources? How will we ensure it’s all available to them? Who do they need to know? Pondering these questions often reveals changes or clarifications which would also benefit your current team members.

Then, once you have new new team member in place, there’s another useful headline question to explore.

What can we learn from the new team member?

A new team member should provide you with a fresh perspective. This can be the case whatever their level of level of experience. So, you can take advantage of this. What are they noticing about working in your team? What have they observed in terms of patient care? How easy is it to work with the systems and processes that are in place?

Empowering your new joiner with ownership of their welcome plan encourages a proactive attitude toward becoming an effective contributor. Discussions around their observations and needs can then take place both formally and informally. This means everyone getting involved in creating the latest version of the team and building for the future. Such an approach creates solid foundations for an ongoing improvement spiral – spiral where joining your team becomes increasingly easy. And that accelerates the process for your future new colleagues becoming effective team members.

What steps are you taking to make it easier for doctors to join your team?

Stephen McGuire – Managing Director

If not now, when?

Let’s expand this blog post’s heading a little. “If not us, who? If not now, when?” Sound familiar? This phrase has seeped into popular consciousness over the years. Who asked this first? Ivanka Trump? Obama? Robert Kennedy? Hillel the Elder? Well, it doesn’t really matter. We should consider these questions now, more than ever.

Our experiences of the global pandemic forced us to take a critical look at our systems. We’ve recognised both strengths and flaws of our health system’s structures, their processes and the multitude of people who constitute the workforce. We can see things more clearly than ever before. We all want an efficient, properly joined-up healthcare system which is truly integrated with social care.

The initial stages of the crisis initiated an incredible burst of energy, creativity and flexibility. We have all revisited our values and priorities, everyone from politicians to healthcare professionals and the general public. It’s been a sobering and exhausting experience.

Here’s another useful quote to add to the mix:

Never let a good crisis go to waste.

Again, it doesn’t matter whether it was Kissinger, Churchill or Machiavelli who said this first. These are wise words. The open-mindedness and momentum generated by high pressure situations often create opportunity. So, great leaders grasp such moments and channel peoples’ energies toward constructive, sustainable change.

However, there’s a predictable stumbling block that we encounter. People cannot function at such high intensity, at maximum and over-stretched capacity indefinitely. Our bright ideas often turn out out to be overly simplistic when points we haven’t considered begin to surface. Knee-jerk reactions and quick-fix plans often turn out to have serious flaws when they face the test of time.

This means that crisis is typically followed by feelings of regression. Yes, we want the new normal, to get to that better place. Yet exhaustion, disappointment and complexity start taking hold and tighten their grip. So, recent headlines such as “Exhausted doctors seek respite before further NHS reforms” are not unexpected. These reports follow the BMA’s response to the Queen’s Speech to parliament, the annual event outlining the Government’s agenda for the forthcoming year. Plans for major reforms of health and social care systems were included this year.

The politicians have a tricky balance to strike here. No-one wants sweeping change at a time when they are struggling. But, at the same time, there is real risk that we lose the momentum and drive required to make the improvements that should be in everyone’s interests.

Closer to home

It’s unlikely that you have much influence over restructures – unless you are in a very senior position, or politically active. It will be a while before there are any direct ramifications for you. So, let’s consider your recent experiences and current situation. Think of your own role and your own team. What have you learned over the past year? What needs changed?

If you don’t take action on these points then you risk losing traction. However you cannot drive change without considering the people who work with and for you. Merete Wedell-Wedellsborg has described how emergency and regression are followed by recovery. Great leaders need to take people with them, supporting people through the journey or emergency, regression and recovery. So it’s essential to learn and refresh the skills required for this. Effective, sustainable change also requires solid management of projects which are both well designed and well executed. Are you prepared for this challenge?

So, if you can see the need for change, pause and consider:

If not us, who? If not now, when? Don’t let a crisis go to waste!

Stephen McGuire – Managing Director

Why do you get it right but others get it wrong?

As the restrictions of our lockdown begin to ease, YouGov have published some interesting survey results of the general population.

  • Q1: Do you expect that the public will or will not behave responsibly when shops, pubs gardens, and outdoor restaurants re-open? 67% of almost 5,000 respondents stated they believed the answer was probably or definitely not.
  • Q2: Do you expect that you will or will not behave responsibly when shops, pubs and outdoor restaurants re-open? 91% of the same respondents stated that they definitely or probably will.

What’s that got to do with doctors?

In 2018, we published the results of our study in BMJ Leader where we asked doctors to self-assess their behaviours within their teams. A representative group of over 200 doctors took part. This included all grades from foundation years to Medical Directors, locums and a broad range of specialties. Here are a couple of our findings:

  • 92% of participants indicated their personal commitment to team goals but 22% doubted their colleagues’ alignment to the same goals.
  • 93% said they are personally willing to take on tasks to support fellow team members but 26% believe their colleagues are unwilling to do the same in return.

Do you notice a similarity with the results of the YouGov poll? These numbers don’t add up. However they are good examples of the same phenomenon that leads 80% of people to believe they are better than average drivers. That simply cannot be true.

The illusion of superiority

These are all examples of the illusion of superiority. And this illusion is just one of many cognitive biases. Put simply people, and that includes doctors, will often behave in irrational but predictable ways. We tend to judge other people by their actions. We think, “You did this or that in the past so I believe you will act this way in future.” And we tend to judge ourselves by our intentions, “I know that went wrong but what I meant to do… what I was trying to do was…”

Modern healthcare is based on teams – hierarchical teams within specialties and multi-disciplinary teams across the board. Teams depend on trust for good, open and honest communication.

Facing into the challenge

These cognitive biases have always been present in human, but are exacerbated by lack of trust. And Edelman have described “a global implosion of trust”. In our study, 20% of Consultant doctors reported they had a lack of trust in their colleagues. If there is a shortfall in trust at leadership level, then it should come as no surprise that such attitudes spread throughout teams. The illusion of superiority, where people believe they do the right thing but others don’t and won’t, grows to the detriment of team interaction and performance. Lack of trust grows and doctors hold back from saying what needs to be said to each other.

So, leaders have responsibility to, first of all, develop their own abilities in having open, honest and challenging conversations, then to foster a culture where members of their team do the same.

What are you doing to develop trust and remove the illusion of superiority within your team?

Stephen McGuire – Managing Director

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