Category: Uncategorised

In his first major speech since taking over as Health Secretary, Matt Hancock said, “I love the NHS, I really mean it.” That’s the good part. He also expressed his horror over the levels of bullying within the service and described how NHS staff feeling “undervalued” is “heartbreaking.” Let’s add these words to those of Baroness Dido Harding, Chair of NHS Improvement. In a recent interview with the BMJ she is quoted to say:

“I am quite shocked at the lack of some of the basics of people management that I would expect to see… It’s awful. The percentage of staff saying that they have been a victim or have witnessed bullying is three, four, fivefold more than you would see in other organisations.”

A long standing problem

Sadly, the only surprise for many readers in these comments is that our new Health Secretary expresses feelings of love and that his heart is being broken. A politician with a heart? Bullying is a topic that we have covered before in blog posts such as Medical leadership or just bullying? Is this simply this season’s efforts of paying lip-service to keep the disgruntled ‘weaker’ members of the service happy?

Well, let’s be clear. Dido Harding is no shrinking violet from a sheltered upbringing. Her father was a British Army Field Marshall who commanded the Desert Rats in World War II. She rose through the ranks of the McKinsey consultancy group before holding senior management roles with Thomas Cook, Woolworths, Tesco and Sainsbury’s. She then worked as Chief Executive of telecoms giant TalkTalk. I’m certain the Baroness knows what bullying is and recognises it when she sees it. The problem is real and not going away.

Something has to change – but what and how?

The way forward

Thankfully, Dido Harding is wise enough to identify the way forward. In relation to the bullying culture, she says:

“I suspect it’s a real indication of an immaturity in the whole system in what good management looks like. Good management isn’t soft and fluffy – good management is about giving or having honest adult conversations. Bad management can often be interpreted as bullying.”

She goes on to emphasise the importance of “thinking about how we plan and develop talent at the most senior level.”

I would suggest that waiting to focus on doctors as they begin to approach senior levels is too late. Dedicated development of skills from the earliest stages of a career and on an ongoing basis will be the only way to truly change this problematic culture. One difficulty is that there are so many other skills for a doctor to learn. Back to Baroness Harding for a few more wise words:

“It’s much easier to teach doctors and nurses to be great managers and leaders than it is to teach me to be a doctor or a nurse. Nonetheless, it’s a skill that needs to be taught and honed and practised – we are never too good at it to not practise.”

And, for balance, she sees plenty potential. “That’s not to say there are not pockets of brilliance – of course there are. I’ve seen examples of some of the best people a management and leadership I’ve ever seen. But it’s unbelievably inconsistent.”

What steps are you taking to play a part in changing the culture of bullying?

Stephen McGuire – Head of Development

Please note: this offer has now ended.

Why are we offering our 1 hour CPD course free of charge?

‘August is here.  For the population at large attention is being directed towards holidays, enjoying longer hours of daylight and making the most of the great outdoors.  In sharp contrast to this season of relaxation, August presents a very different stage in the annual cycle for doctors working in hospital.’

These were the words that we used a few years ago to open our blog-post titled August: A challenging time for doctors. In that piece we considered the potential stress and drama that occurs each year at the beginning of this month. Hospital wards across the UK welcome a fresh cohort of inexperienced university leavers who are taking a major step in their development as a doctor. At the same time, many other junior doctors are beginning their next rotation.

“Unfamiliar surroundings; new people; abilities being tested and stretched.  What could be more exciting!” was the closing line from that blog-post.

Whether you are beginning your very first placement, are changing to a new team or you are an experienced team leader the resulting team transitions make August an excellent time for all involved to pause for thought. There are many questions to consider in relation to the function and development of the team and the role that you play.

• How can I best prepare?
• What do my colleagues need?
• How do I let them know what I need?
• How is the team developing?
• What can go wrong?
• How do we avoid the pitfalls and make ourselves stronger?

To do our bit to help we have decided to give free access to our popular 1-hour online CPD accredited course Healthy Teams in Healthcare to everyone until 12th August 2018.

Click here for your free access to Healthy Teams in Healthcare

About Healthy Teams in Healthcare

During this online course, which would normally cost £40, you will be introduced to various models related to the development, function and dysfunction of teams. You will explore various aspects of these models, clarifying both how issues arise and the solutions to help avoid or resolve these challenges. You will then complete the Healthy Team Member Self-Assessment which will support you to consider the various strengths and challenges within your own team. Once you have completed and submitted the reflective learning statement at the end of the course you will have identified where you need to focus your attention, along with actions to improve your involvement and/or strengthen your team for the benefit of all concerned.

At the end of the course you will be asked to complete a reflective learning statement, submitting this to Oxford Medical Training in order to receive your CPD certificate.

We’d also encourage you to share this link with your friends and colleagues. Sharing and discussing your results together could prove to be the first steps in making significant progress to your integration into the team, to your leadership, or to your team’s development.

Click here for your free access to Healthy Teams in Healthcare.

We are delighted to announce two new locations for selected Oxford Medical Training Courses: Bristol and Newcastle-Upon-Tyne. For a limited period only, we are offering you courses in Newcastle for 10% below the standard prices.  Offer ends soon. Places are limited so make your booking now to avoid disappointment.

Courses currently listed for Newcastle-Upon -Tyne include:

• Teach the Teacher Course for Doctors
• Practical Leadership & Management Course for Doctors

Courses currently listed for Bristol include:

• Teach the Teacher Course for Doctors
• Essentials of Medical Leadership & Management
• 2 day Advanced Communication Skills Course for Doctors
• Advanced Patient Communication Skills Course for Doctors
• Advanced Team Communication Skills Course for Doctors

More choice, more opportunity

Our ever-growing list of locations offers you more choice. You may find it easier to find the course which interests you closer to home. Alternatively, why not combine your learning experience to visit friends and family or even to explore a new city. From north to south, our full list of cities for regular courses now reads:

• Glasgow
• Newcastle-Upon-Tyne
• Leeds
• Manchester
• Nottingham
• Birmingham
• Oxford
• Bristol
• London

Which location is best for you?

A consultant medical interview is likely to be a pivotal point in your life.  Your performance on the day is likely to define your career for years to come.  The interview which you face is the culmination of your many years of dedicated development.  Quality of performance on the day can be directly related to quality of preparation.  With so much at stake it is therefore essential to undertake this task as effectively as possible.

At Oxford Medical Training, we have specialised in Consultant Interview preparation since 2004 and understand the challenge ahead.  Our experience in supporting thousands of doctors has led us to develop both the medical interview skills courses which we run regularly across the UK and this comprehensive guide book.  The structure which we use is designed to help you perform at your very best in terms of both style and substance.

Regardless of whether you are working on a time scale of days, weeks or months, it helps to consider your preparation as a project.  Any well-run project begins with the explicit definition of aims and purpose.

From our experience, we realise that there are a few common misconceptions of what is going on and the process which will be undertaken.  Many of the delegates who attend our Consultant Interview courses have the mindset that they are about to undergo some form of pass/fail test.  They expect that they are about to face an examination of their clinical skills and their knowledge of the structures of the NHS.  Success, however, is more likely to be achieved through better understanding of the process which will be used and the reasons for this.

For any job application process, regardless of profession, there are three obvious sets of stakeholders.  Each set has their own complementary objectives.

Objectives of stakeholders to an interview process:

• The organisation which wants to fill its vacancy with the most suitable candidate available.
• The applicants who each want to secure the position for themselves.
• The interviewers who want to establish the relative suitability of each candidate.

We will use the term ‘organisation’ in broad terms here to represent the body which is undertaking the recruitment: Trust, Health Board, hospital, department, etc.

If you are successful in securing an interview then you will generally be considered to have demonstrated you have the technical/clinical skills and abilities required to fulfill the role.  We will look at this further when we describe the selection process which is utlilised by organisations for recruitment to a Consultant vacancy.  The same is true for all the other doctors who reach this stage of the process.  A Certificate of Completion of Training (CCT) or equivalent and inclusion on the Specialist Register of the General Medical Council should count as proof of your skills.  In other words, you have already passed the test!  So, the interview is not about establishing your clinical credentials.

Neither is it a test of your knowledge of which of the numerous organisations which make up the NHS are responsible for what task or to name the key reports which have been published on particular topics.  If it were, then the organisation could save themselves a lot of time by giving you a multiple-choice questionnaire or some other written exam.  Being able to demonstrate a working knowledge of the challenges and your ability to function within the system are definitely relevant.  This is, however, quite different from being able to recount raw facts.

When we are job applicants, we should ideally be aligned to the organisation’s objectives.  In this case they are unlikely to be simply looking for the most technically brilliant ‘…ologist’.  It is crucial that they avoid appointing the ‘wrong person’ – no matter how clinically brilliant they happen to be.  The role of Consultant goes well beyond your direct investigation, diagnosis and treatment of the single patient who sits before you in your clinic.

Your prospective employers are more likely to be looking for someone who has the attributes to fulfil all aspects of the role which they have in mind.

The organisation will be wanting to appoint the person who is best equipped to meet and exceed the current and future challenges required for the role in every respect.

They are likely to be looking for someone who shares their values with good levels of self-awareness.  The range of attributes which they seek will typically include someone who:

• works as a team member and provides leadership to others
• builds relationships with colleagues and teams of all levels
• is organised and gets things done
• makes tough decisions in difficult circumstances
• interacts with the system and makes the most of limited resources
• supports the development of colleagues and junior doctors
• is emotionally intelligent and resilient
• supports others when they are struggling as required

Between the organisation and the applicants sit the interviewers.  They are the human face of the organisation who are tasked with establishing and evaluating the relative suitability of each candidate for the role.  They will seek to fulfil their task by exploring how you work and interact with others in real world scenarios, as well as by probing previous actions and current opinions.  To achieve this, they must conduct their assessments in a fair and consistent manner.  Gaining consistency between individuals on subjective matters is always a challenge.

It goes without saying that your over-riding purpose for putting yourself forward for interview is to secure the post.  So, how do you ensure that your aim for your performance on the day is aligned to the requirements of the organisation?

Many applicants take the approach that the Consultant medical interview is some kind of pass/fail test. It is more helpful to consider it as your opportunity to demonstrate how you can bring added value to the organisation.

This text is an extract from the opening pages of the Oxford Medical Consultant Medical Interview Guide 2018-19

There are times when we need to hear what we need to hear. We need to hear what we are not doing well enough, what we have missed, the problems we have caused others. We need to hear what we need to do more or do less, what to change, what to start and what to stop. We need to hear how we can improve.Though some of us may have well developed levels of self-awareness, none of us can be fully aware of all our short-comings or the impact that we have on other people without help. We all need these things brought to our attention. We need other people to let us know. In many ways, for us to hear what we need to hear, we depend on those who we work with to say what needs to be said.

When should we be saying what needs to be said?

The topic of saying what needs to be said come up in many of our courses. In our Teach the Teacher Courses we explore the need to bring things to the attention of those who are learning from us. In our Essentials of Medical Leadership and Management Courses we discuss initiating/embedding change and dealing with under-performance. During our Advanced Team Communication Skills Course we address the need to bring things to the attention of our leaders and our colleagues. Even on our Medical Interview Skills Courses we work with delegates to make sure they are able to raise controversial subjects and inform a prospective employer of the improvements they need to make to their department or organisation.

Shortcomings in giving feedback or critique, raising challenge or simply bringing things to the attention of others in these contexts can have major consequences. People and teams fail to reach their true potential. Safety issues increase, errors multiply and mistakes are not addressed.  Standards slip, inefficiency is accepted and initiatives fail. It has direct relevance to honesty and integrity. It can even be argued that the Duty of Candour starts with the communication between healthcare professionals. If we don’t speak up then we become part of the problems which surround us. These are just a few examples to illustrate why doctors must skilled in saying what needs to be said. Yet there is a problem.

Trouble saying what needs to be said.

Our published research, based self-assessment by over 200 doctors, has identified a shortfall in sharing feedback and challenge.  Significant percentages say they don’t do this enough or even at all. (Please note that the emphasis here is on face to face discussion, rather than annual anonymous feedback via a digital portal). There are likely to be numerous reasons for this.

We all know it can feel awkward and uncomfortable when we receive criticism or when someone disagrees with us or challenges us. So this may inhibit our willingness to speak up. The medical professions also have a long established culture of hierarchy. So this may make people feel it’s not their place to say something. Bullying is all too often allowed to persist through lack of challenge.  The perception of bullying and team friction can be the result of clumsy critique or challenge. In addition, many doctors have not learned how to speak up and challenge their leaders, peers or learners. They don’t know how to say what needs to be said in a way that it will be heard in a constructive manner.

So what needs to change?

Examples of poor quality critique are abundant in our entertainment media. Alan Sugar and Gordon Ramsey have prospered through barking insults and put-downs. On the X-Factor and other talent shows the judges are often heard telling someone, “You need to take it to the next level,” or “You’re not very likeable.” What can the contestants do with feedback like that? There are parallels here with the reviews which some doctors place for our services on the independent TrustPilot website. We genuinely want to know what we are doing well and what we should improve. Yet a comment along the lines of “Great course full of useful resources and information. I would not hesitate to recommend to a colleague” being followed by an award of 4 stars out of 5 can only ever leave us wondering if we somehow fell short and how we could ever get that 5th star.

The receiver needs to clearly hear what it is that they needs to address so we must communicate this clearly and constructively.

How clearly are you saying what needs to be said? Are you and your colleagues hearing what needs to be heard?

Stephen McGuire – Head of Development

The tragic case of little Jack Adcock, which culminated in Dr Bawa-Garba being found guilty of manslaughter through gross negligence, has thrown the spotlight on reflective writing.

I’ve always been a strong advocate of the practice. It is the focus of my previous blog posts Detach or connect – a medical dilemma? and A prescription for being a better doctor. There are multiple benefits, including exploration of significant incidents and personal learning. It can also play a major part in developing patient connection with emotional control, as opposed to practicing with disconnection, and in developing sustainable resilience. Until recently, a large proportion of doctors who we explored this approach with on our courses found reflective practice very useful. There have always been some who resisted the idea. Often struggled to get past a dislike for the seemingly endless need for reflective statements from training programmes and appraisals which were then never properly utilised.  Dr Bawa-Garba’s conviction has now introduced an additional complication: anxiety.

Should doctors be concerned?

There is a commonly held belief that Dr Bawa-Garda’s reflective writings were a key element of her conviction. Yet this doesn’t stand up to scrutiny. To quote from the General Medical Council’s case factsheet:

The Medical Protection Society (MPS), which represented Dr Bawa-Garba at her criminal trial, has made it clear that the doctor’s reflective notes were not part of the evidence before the court and jury.

Modern-day doctors adhere to the idea of practicing evidence-based medicine. This should extend well beyond clinical diagnosis and treatment. An evidence based attitude should extend to to all aspects of practice. So it’s important to pay attention to the facts of the case, rather than hearsay and prevailing opinion.

What is correct, and always has been, is that reflective writings could be used as part of a legal case against a doctor against a doctor. There is no statutory restriction in place. But there never has been. Is that fair?

We have to protect ourselves from a mindset that doctors can do no wrong. Although Dr Harold Shipman is undoubtedly an extreme case he is worth a mention. If we know a doctor can genuinely be guilty of the premeditated mass murder of patients, then it is not difficult to imagine that there is a sliding scale on which, somewhere along the line, there could be examples where manslaughter through gross negligence would be a fair and reasonable conclusion. The public deserves to have confidence in their doctors and no-one can ever be above the law. Any successful criminal prosecution depends upon all relevant evidence being presented and considered. The emphasis has to be on the word ‘all‘. If a doctor’s personal written reflections were to be used in court – and they weren’t in the Bawa-Garba case – then they would constitute only a part of the evidence. There would have to be sufficient corroborating evidence to indicate any guilt.

Consider this: if reflections could be used to support a prosecution then they could also be used to support a defence case. Would there be equal levels of panic used if a doctor wanted to utilise their reflective diary to help evidence their innocence?

An example of defensive practice?

It could be argued that active avoidance of reflective writing has a parallel to the concept of defensive practice. The focus has shifted from what is in the best interests of all concerned to the avoidance of litigation. Unnecessary tests, appointments, referrals and treatment processes for the sole purpose of covering the clinician’s back cost the NHS heavily. The costs to the service are both financial and in terms of efficiency. Ultimately the wider service to patients is compromised. There is also a world of difference between a clinical record which has been written to genuinely communicate the patient’s story and one which is intended as proof and justification in case of complaint. Is there any difference between these self-serving behaviours and making a conscious decision to opt out of a worthwhile self-development activity in the remote chance it could play a part in some undefined litigation?

Simple steps for genuine reflective practice.

Without doubt, the conversation about helping doctors find a way to reflect without fear is a positive one. At the same time, it is clear that many have never actually been taught how to conduct a reflective writing exercise for ‘right’ reasons. Please note: the following description is of reflective writing for your personal benefit, rather than for an appraisal submission.

To be successful, you must be willing to genuinely explore your experiences, thoughts and feelings along with your perception of the experiences, thought and feelings of anyone else involved.  Give yourself the time and space for the following:

• Set a timer for 20 minutes
• Using pen and paper, or keyboard, write about your experiences over the past week – or the event in question
• Punctation, grammar, spelling, legibility etc. are irrelevant for this exercise
• Write only for yourself
• Go wherever your mind takes you with curiosity and without judgement – and keep writing, no matter what comes into your head
• When the time is up, throw away the paper or close your digital document without saving

The final point here is nothing to do with the concerns arising from Bawa-Garba case. This is the long established process advocated by James Pennebaker, a leading author on the topic of reflective writing. It is consistent with the original intention: to externalise the information from yourself without fear of repercussion. Refelctive writing slows the mind, creates focus and enables stepping out of the experience to gain perspective.

However, there are other effective methods beyond reflective writing. A coaching-style conversation with a trusted  and skilled mentor is one valuable alternative. Speaking can be just as beneficial as writing and a good mentor could help you explore aspects of which you would otherwise be unaware. We will therefore be increasing the focus on the skills required to facilitate such reflection going forward within our Advanced Teach the Teacher: Mentoring Skills for Doctors.

Stephen McGuire – Head of Development

On 5th July 1948 the NHS was born. That means in a couple of months this grand old lady will be 70 years old. At an age when most people would be retired and enjoying life at a relaxed pace she is having to work harder and harder than ever before.  More and more is expected from more and more people with restricted resources. She is definitely experiencing some health problems of her very own. It all makes you wonder:

What is the life expectancy of an NHS?

Although no-one knows the answer to this question, many commentators openly speculate. But no-one has ever had a patient like this and certainly not one with these symptoms – or have they?

Let’s go back to the start.  The NHS had a very difficult birth. Though it may be surprising to hear, not every doctor was on her side and would have preferred to ‘let nature take its course’. Dr Alfred Cox, a former Medical Secretary of the BMA, has gained a degree of historical notoriety from his assertion in 1946 that the plan to develop the NHS was “like the first step, and a big one, towards National Socialism as practiced in Germany.” He went on to liken Nye Bevan, who was championing the cause, to a “medical fuhrer” who would “strike down doctors’ cherished professional independence.” If the NHS is often treated like a political football in the present day then it is apparent that this is not a new phenomena.

Much of the current woes arise from the challenges in financing the service. Again this is nothing new. As far back as 1951, with the NHS struggling past its infancy, Prime Minister Clement Atlee proposed the introduction of prescription charges to address the monetary problems. Although this led directly to the collapse of his Government, these charges came into effect the following year. So, as well as being a political football, the NHS has been in financial troubles throughout her entire life.

What’s the simple answer?

If only there was one.  Publicly funded healthcare is incredibly complex. There are multiple challenges. Unfortunately, when faced with such complexity any small action can appear futile or simplistic and we become hopeless. It’s easy to get trapped in an increasingly negative downward spiral.

Much of the time, the debate around finding a solution is focused on financing.  We all want the best care we can receive but how much are we as a society and individuals prepared to give up to fund the NHS? That can lead to a 2-dimensional debate. It helps to balance this with a third dimension – controlling costs. Discussions on controlling costs can easily be lost in accusations of simplistic cost-cutting, being unrealistic or unfair. Yet we are regularly confronted with tangible examples.

Marginal gains

The most recent edition of the BMJ (361:127-168 No 8151) leads with the cover headline, “Emollients for childhood eczema: money down the drain?” which questions the benefits of emollient bath additives. Relevance of continued provision of this treatment is now being hotly debated – expect a strong counter argument by the pharmaceutical suppliers.  But even if a proportion of the £23.1 million being spent on its supply can be saved without any impact then this would appear to be a small step in the right direction.  The idea that “there is no such thing as an insignificant improvement” leads to the concept of the aggregation of marginal gains.

There are others. Lord Carter’s 2016 review into ‘unwarranted variations’ made the bold claim that £5bn could be saved in England alone by addressing long standing poor practice in relation to running costs, absence, infection rates and supplier costs. Little surprise then than current focus within the NHS includes staff well-being and sepsis. Further savings may be possible by really looking into the subject of defensive practice with the related unnecessary investigations and appointments.

Not that any of this is easy. For example, a common point of discussion during our Advanced Patient Communication Skills Course is how to deal with the demanding patient.  You will be familiar with constant pressures for procedures, anti-depressants, antibiotics or an equivalent from your personal discipline. GPs and dermatologists are likely to face similar pressures from parents who fear what reaction will occur from ceasing emollient bath additives.  They may well perceive it as a cut in the level of care they are receiving. Education is an essential part of any change.

The problem with the marginal gains idea

Every little instance of waste being halted contributes to the aggregation of marginal gains. Will it be enough to save the NHS? Probably not. It’s easy to imagine the NHS always existed. Yet she’s only 70 years old. And just like any old lady that we love, it’s hard to imagine here no longer being with us. But its possible this that could turn out to be another example of the circle of life?

The ultimate end point for the accumulation of marginal gains is easier to predict.  You eventually reach the peak of the mountain with nowhere to go. So it can only ever be a part of the answer. Will we ever be able to make the transformational leap to a different mountain and a new system? Possibly. But until we know what that mountain looks like, there are many marginal gains for us to be getting on with.

Stephen McGuire – Head of Development

The subject of lecturing and presenting is one which we discuss regularly on our Teach the Teacher Course of Doctors. Without doubt, a well planned, well delivered lecture by a great speaker on an appropriate subject can be very, very effective. It is a good option where audience numbers are large and the focus is on knowledge. You can guarantee your explanations, ideas and messages have been made available to each and every learner in a consistent manner. Many medical schools have large cohorts of students at each stage level of development. Many conferences are staged at large venues with lectern, screen and microphone. As a consequence, the lecture has become a default style of teaching for doctors around the globe. But is it always the best option? To lecture, or not to lecture?

That is the question

On our course, we begin by exploring the theory of adult learning. Although we all have our individual preferences, there are some universal truths. One of these truths is that our ability to pay attention, grasp concepts, interpret information and then commit them to memory is directly related to stimulation of our senses and intellect. Good lectures certainly stimulate our aural and visual senses. They can also be designed to stimulate intellect. However such an approach to teaching misses many vital ingredients. As numbers of learners decrease, any sole reliance on lecturing becomes increasingly absurd and misses many opportunities. In addition, your ability to practice as a doctor goes well beyond knowledge alone.

Imagine talking with a group of friends

Can you really develop skills such as manual dexterity by universally addressing the crowd? If you were trying to explain something to them would you present for 45 minutes in the manner of a television broadcast, then offer them 10 minutes for questions – or would you do something else? Taken to the extreme, if you were aiming to help just one person learn something, would you deliver a lecture?

In addition to being exposed to theory, the vast majority of learners relish the opportunity to discover things for themselves. As well as learning from observing others they need to experiment and practice. Our attention levels are boosted through engaging with other people and through movement. In short, we all benefit from interactive, experiential approaches to learning.

Versatility starts with mindset

When tasked with helping a group of people learn about something, many of the words which come to mind drive us in the direction of delivering a broadcast style lecture. “My presentation”, “I’m doing a talk”, “I’ve been asked to speak about…” are just a few of the examples. A simple shift is to take the view that “I am running a teaching session”, or, even better, “I’m helping this group of people to learn about…” Connecting that paradigm with a little creativity opens the window to a very different experience for the learners.

So, although a lecture has its time and place, it is only one of the methods that you can utilise to help enable others.

Stephen McGuire – Head of Development

Focus on medical leadership has been increasing in recent years. The benefits are well documented. It is well accepted that good leadership brings mutual benefits for patients, organisations and individual doctors. However the concept of leadership varies to some extent between different authors. I’d summarise it as ‘getting things done through other people’. That’s a simple memorable statement which could easily be accused of disguising the complexity of the challenge. The overall intention of medical leadership is fairly easy to define: effective, efficient and compassionate patient care. That’s the end result. The big question is, ‘how to achieve this?’

The direction of leadership development

Much leadership discussion and development is directed toward the human interaction between leader and follower. This idea would seem to sit very comfortably with the concept of ‘getting things done through other people’. However, the concept of leader and individual follower misses the point that the follower will, more often than not, have to work with others to achieve the desired outcome. Modern healthcare is delivered via groups of people, rather than by individuals. A single patient is likely to be cared for by a consultant plus ST and Foundation doctors from the same specialty. They may well require care of doctors from more than one specialty. They have their own GP. Locums cover holidays and absences. Nurses and a broad range of other health or social care specialists could be involved. For the patient’s care to be efficient and effective these various professionals must act together as one functional team.

The problem

Groups of people do not automatically form coherent teams. It requires dedicated focus. As such, this is a matter for medical leadership. My peer reviewed research into the team interaction behaviours of over 200 doctors has now been published in BMJ Leader. It identifies a number of issues. The self-assessment of the participating doctors indicates:

• 45% are not challenging or giving feedback to their colleagues
• 42% are not proactively seeking honest feedback
• 40% are not discussing progress toward goals
• 39% are not discussing the support they require to fulfill their role
• There are also significant mismatches in perception. Attitudes of “I am committed but others are not” and “I am willing to help others but they are not willing to help me” are also apparent.

There must be questions here about the Duty of Candour. The suggestion is that doctors are seeing things which are not good enough, even wrong, yet not discussing this with their colleagues. At what point does the Duty of Candour actually begin? The shortfall’s in team interaction must have direct on the delivery of patient care, efficiency of organisations and the day to day experience of individual doctors.

 The challenge

Efficient, effective, compassionate patient care is the headline goal. To achieve this, leaders must focus on teams as much as they focus on individuals. Great teams don’t just happen. They have to be consciously nurtured and maintained.  Leadership development must therefore go beyond the ability to influence and support individual followers. Great leaders take proactive steps to gain insight into the complexities of team interaction and communication skills.

What steps are you taking to improve your team leadership?

Stephen McGuire – Head of Development

Leadership and management is of increasing importance for today’s doctors.  At the same time, online training is increasingly popular.  So we’re delighted to introduce our new Online Medical Leadership & Management Course which is accredited for 3 CPD points.  The course is delivered in 10 short modules which you can access anywhere that you have an internet connection. Here’s a sneak preview of the 2 minute introduction video.

 

Click here for more details.