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Leadership is often hailed as the solution to the countless challenges which healthcare faces.  It is unquestionably important.  In their Leadership and management standards for medical professionals, the Faculty of Medical Leadership and Management emphasise the benefits it can bring for patients, doctors and individual doctors alike.  As a result, many doctors proactively seek out CPD training on the subject.  They want to lead well and to get things done.  Gaining a Certificate of Completion of Training (CCT) will also typically expect evidence of participation in leadership and management courses.  Is there a risk, however, that such focus is too one-dimensional?

Four dimensions to consider

• Leadership
• Followership
• Team membership
• Interdependence between teams.

Unless you are the owner of your practice or leader of organisation then you are also a follower.  You follow your organisation’s more senior leaders.  You will also be a team member – potentially of a leadership team – and the team you lead must work in conjunction with other teams to deliver your services.

Good followers are much more than passive individuals who follow orders without question.  They keep their leaders informed, proactively seek clarity, constructively challenge at the appropriate time and propose ideas.  They then use disciplined initiative, following the direction of their leaders as they fulfill their role and lead others.  The best leaders have a firm grasp on what makes a good follower as they are typically good followers themselves.  Great leaders forge strong communication channels with their own senior colleagues to help their organisation move forward in a unified direction.  They know the challenges of being a follower and use this to support those they seek to lead.

Truly unified direction within a large organisation can only be achieved through leadership teams.  Great team players communicate effectively with each other, share clarity of purpose, processes, roles and responsibilities.  The best leaders work with their peers to achieve these conditions.  As they understand team dynamics they create the culture where they foster great teamwork between the people that they lead.

In this modern era, where multi-morbidity is increasingly common, coordinated health and social care is dependent on a plethora of multi-disciplinary and specialty teams.  The route to effective and efficient provision of care is through quality communication and interdependence between these teams.  Great leaders enable this as they, once again, have a good grasp on the need for these conditions and have developed the skills to interact with other teams.

 Support from above, below and alongside

So an irony of being great leaders is that we have to be great followers, great team members and great connectors with other teams.  Great leaders recognise the problems which arise through isolation or any shortfalls in each of these four dimensions.  Everyone, from top to bottom and across an organisation needs support from above, below and alongside.  In truly great organsations each and every member strives to achieve this.  Medical leadership and management courses must therefore be designed and delivered with awareness of these challenges mind.  And, in addition to courses directly labelled for leadership and management, great leaders should seek to develop strong team communication skills.

What steps are you taking to become a great leader?

Stephen McGuire

Head of Development

The series events which have led to Dr Hadiza Bawa-Garba being struck off the GMC register after being found guilty of manslaughter have brought the management of healthcare errors into the spotlight.  In response, Jeremy Hunt emphasised “If we are going to keep patients safe then we have to make sure that doctors are able to learn from mistakes.”  It has to be accepted that mistakes are inevitable in complex systems.  As the old saying goes, “To err is human.”  This does not mean that we should accept everything that goes wrong.  Incidents and near misses should always be thoroughly reviewed and it is essential to differentiate between the honest mistake and true negligence.  But how to ensure that investigations come to the right conclusions?  These are matters which we discuss during our Practical Leadership & management Course of Doctors.

Reviewing the review process

In October 2015 the Care Quality Commission reported on their investigation into reviews being conducted within healthcare stated, ‘In our review of the quality of investigations into serious incidents involving patient care in acute hospitals….. we conclude that while investigation of serious incidents is often seen as one of the most important elements of the patient safety process, this can be counterproductive if not done well’.

They went on to emphasise the purpose of investigations in such circumstances: ‘to identify significant opportunities for learning to reduce or eliminate the risk of the same thing happening again.’ before highlighting the following points:

‘We have observed a high number of investigations that:

• show a lack of skill and expertise in the methodology used.
• do not identify the underlying systems issues that led to the incident; or that leave the reader with unanswered questions.
• There was also limited evidence that patients and families were engaged in the process, or that clinical and other staff were sufficiently involved’.

In the same year the UK Government Select Committee Report stated: ‘The focus of investigations into ‘never events’ was ‘preoccupied with blame or avoiding financial accountability.’

Further pitfalls

Though conducting a review sounds fairly straightforward, doing it well takes dedicated effort and a degree of skill.

One potential pitfall is to confuse correlation with cause and effect.  Just because a relationship exists between two factors does not necessarily mean that one is the cause of the other.  For examples: when the Czar found out that the most disease-ridden city of the empire was also the city with the highest number of doctors, he ordered the execution of all doctors in the state.  A logical conclusion and course of action?

At the other end of the scale the writer Malcolm Gladwell explores the idea in a number of his books that too often we find ourselves drowning in facts at the expense of true understanding.  Being able to list off the events which led up to a past event does not automatically mean that you understand what actually caused the event and how to either avoid or repeat a similar occurrence.

Further difficulties arise from the phenomenon of creeping determinism.  It can be all too easy to examine an event, establish the trail of incidents which led up to it and to conclude: “How did they not see that coming?” or “Why did they not do something about it before it got to this stage?”  This type of thinking is of response is often observed in reaction to everything from terrorist attacks and the outbreak of wars, all the way down to team performances where football pundits assess why your favourite football team lost a goal.

The way forward

The same processes and principles which guide quality investigation into problematic incidents have equal relevance to situations where things have gone well.  Why were we successful?  What did we do differently?  This helps to reinforce the positives rather than simply focus on the negative.

For unwelcome events, the differences between negligence, incompetence and human error must be understood and the true reasons identified.

• True negligence is unacceptable and should be treated as such.
• A conclusion of incompetence leads to numerous further questions before the correct course of action is identified.  Were they consciously or unconsciously incompetent?  Why was the incompetent person put in this position?  Could the series of events been reasonably predicted – given everything else that was taking place at the time?
• Where the cause is human error the next question has to be :”Why was human error possible?”  That’s where the true issues are likely lie.  And to quote the full version of the the 18th Century poet, Alexander Pope, “To err is human, To forgive, divine.”  This may be easier said than done than the patient or their family who have suffered harm as a result which puts understandable pressure to find answers.

The CQC’s report concluded, ‘it is important that providers develop expertise and invest in the tools needed to properly investigate, so that the right lessons are learned and shared.’  What steps are you taking to improve your skills in this area?

Stephen McGuire – Head of Development

There are many reasons why you, as a doctor, may need to deliver a presentation.  You may be involved in teaching or have to demonstrate learning.  You may want to share the output of some research.  Alternatively, you may need to present a business case to decision makers or share some information, such as a new way of working, with your team.  Sometimes, if you are applying for a training or consultant post, you may be required to deliver a presentation to an interview panel.  The skill of being a great presenter is a regular topic of discussion on a number of our courses.

So who are the great presenters?

Great presenters are all around us.   It’s always easy to consider this on the grandest scale.  We see them at conferences, TED talks, on radio and television.  They include educators, leaders, politicians, news readers, journalists, documentary presenters and even comedians.  There is a huge variety of styles: the energetic too the calm; the humourus to the serious; the eccentric to the ‘everyman’ and much, much more.  Although they may be influenced by others, the best presenters deliver the task via the best version of themselves for context.  Having their own style gives them authenticity which is a major contribution to their influence.  What they all have in common is that they broadcast their information to us in a manner which we understand and hold our attention.  This doesn’t just happen by chance.

But we also meet great presenters in our everyday lives.  We all know people who excel at delivering information in meetings, at shift handovers or in smaller scale teaching scenarios.  They typically make good use of of thorough preparation, organisation and practice.

How can I effectively prepare for a presentation?

Quality preparation can be split into a few headline categories.

• Establishing absolute clarity of purpose
• Conducting thorough research
• Creating the structure and materials
• Preparing yourself

Establish clarity of purpose

This is the first step.  What is the point of this presentation?  Why is it required?  What do I want to be different once I’m finished?  Explicitly defining our answers to questions of this nature gives us direction that guides and focuses our direction to keep us on track.

Research is the next step.

Gather all the relevant information, facts, figures and references which you require to fulfill your purpose.  Even if the reason for delivering the presentation is to share the output of a research project there is still research to be conducted.  Who are your audience?  Why is this relevant to them?  What level of experience do they have in this subject?  What have they been doing before and what will they be doing after the presentation?  How much variation is there in the answers to these questions?  Quality research will guide the development of your content, help you to decide what to include along with what to leave out, plus help you identify key messages.

Structure

Now you need to structure the delivery of your information and create any supporting materials which will help you to achieve your purpose.  There are endless options for good structure.  You could choose any one the countless approaches to story telling.  Alternatively you could stick to the tried and tested ‘News at Ten’ approach: tell them what you are going to tell them; tell them; tell them what you told them.  A good slideshow and set of written notes distributed in the right manner will hold your audience’s attention and help them to absorb your information.  Too often though, PowerPoint slides are used as prompts for the presenters benefit, rather than created for the audience.

Prepare yourself

Next, you need to focus attention on preparing yourself.  What else do you need to do that will enable you to perform the task with confidence?  A bit of nerves can be a good thing, keeping you on your toes.  However, you must take steps to keep them under control.  It helps to practice your delivery and to take feedback from someone you trust in a safe environment.  Our 1-day Advanced Teach the Teacher: Presenting and Lecturing workshop for doctors is an ideal way to do this. You may well also be able to draw parallels between managing your nervousness regarding presentations and the methods you employ to prepare yourself for other challenging tasks.  For examples, how do you prepare yourself for breaking bad news to a patient or their families?

However, there is one big question that you should always ask yourself when you are planning to deliver a presentation.

Is a presentation the best approach for this task?

We study this question in depth during our 2-day Teach the Teacher Course for Doctors.  Many people take the presentation approach when there are better options.  A presentation or lecture works well when you have a large number of people.  Unfortunately, it has many limitations.  Smaller groups offer the opportunity for more interactive approaches.  Interactivity helps to hold people’s attention and can enable self-discovery and experience which accelerate changes to knowledge, skills and attitude.

Stephen McGuire – Head of Development

Let’s start with a rhetorical proposition.

Imagine there is a new pill. Anyone who takes it experiences happiness forever after. Would you take this pill? Do you want to be happy forever? If you did take it, how long would you retain the concept of happiness?

Just as facing into glorious sunshine means we have a shadow behind us, our moments of basking in true happiness are most likely to exist where darkness lies somewhere in our past.

As we come to the end of 2017, I’ve been reviewing my Oxford Medical Insights blogs from this year. The item which created most discussion, by far, was Detach or Connect – A Medical Dilemma. This piece was written in response to the words of Dr Helgi Johannsson in the BMJ in the aftermath of the Grenfell Tower disaster. Dr Johannsson stated, “I feel I am a better doctor for giving myself permission to stop, reflect on what has happened, an to grieve.”

The problem.

Re-reading my blog, I can see that I make the case for emotional connection with patients. This was welcomed by many doctors. Practicing with detachment is a simplistic, short-term approach with problematic, long-term consequences. It can be compared to an attempt to take the magic pill described above. Empathy fosters connection. Connection fosters trust. Trust increases efficiency and quality of outcomes. To paraphrase Steven R Covey, “Change happens at the speed of trust.” However, I can also see that there was not much offered in the way of how to achieve this.

Over the past few months, the need for practical solutions in achieving this became more and more apparent. During a seminar at the Leaders in Healthcare 2017 conference, patient communication experiences were being discussed. The good, the bad and the ugly. The sentiment that empathy can’t be taught was heavy in the air. In another situation, during an Advanced Patient Communication Skills Course, one doctor stated, “I cannot be weeping in the corner when there is a crisis to be dealt with.” It can be difficult to have the alternative message heard.

Seeking a solution

In finding a solution we have to start with belief. If it is possible to learn emotional detachment then it must also be possible to learn how to practice with connection. But how?

Let’s return to the full quote from Dr Johannsson which I used in the original blog:

“I am much more emotionally affected now than I was on the day. Some would say we must remain emotionally detached and equate that with professionalism, but I am human. I feel I am a better doctor for giving myself permission to stop, reflect on what has happened, and to grieve.“

It helps to read this alongside the words of Viktor Frankl:

Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and freedom.

But where is that space? Our primitive emotional reactions kick in five times faster than our thoughtful, rational and logical processes. Our autopilot reactions are even faster still. So where is the space to create emotional control and empathic connection? It is unlikely to be in the heat of the present of an intense or critical situation.

One solution will be familiar to the majority of doctors but under-utilised by many. Since the mid-80’s, James Pennebaker has championed expressive writing as an approach to supporting people to deal with traumatic situations. Reflective, expressive writing is an excellent example of utilising the space which Frankl describes. Its a means of effectively re-programming our autopilot and nurturing constructive quick-fire emotional responses. Numerous studies by a variety of researches in a broad range of fields have explored the positive benefits that it can have. Expressive writing by patients has been found to improve feelings of well-being, reduce numbers of appointments and even promote improved wound healing.

But that’s patients and ‘other people’. What about doctors? Well its probable that you will have been introduced to the concept of ‘reflective practice’ in the earliest stages of your career. You will write reflective learning statements to support your CPD. You will produce a wealth of reflective documentation to support your progress and appraisal processes. Unfortunately, what is intended as a powerful tool to support development can become under-valued. For too many it has become an unwelcome, repetitive, perfunctory requirement. Any tool used with a lack of understanding, care or attention is likely to offer poor results. In contrast, when placed in the right hands and used with skill, the results can be something special.

Pennebaker’s approach is remarkably simple:

• Set a timer for 15 minutes, (some people prefer to do 20 minutes)
• Write about your experiences over the past week
• Go where your mind takes you with curiosity and without judgement
• Keep writing for the full time
• Write only for yourself
• When the time is up, feel free to throw it away what you wrote or store it away to re-read in future

Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and freedom. You would be unwise to take the forever happiness pill. The positive alternative is a prescription for regular genuine, reflective, expressive writing.

Stephen McGuire – Head of Development

Keeping large amounts of information organised has always been a challenge. A significant number of doctors describe to us how they are struggling even more in recent years.  The amount of documentation to be maintained has increased with the statutory requirement of annual appraisal. This has coincided with a major shift from physical paper toward the digital world. At the start of 2017 we became part of this change, supplying our CPD certificates as PDF download rather than on card. We did so as a majority of doctors expressed this as their preference, helping with management of the e-portfolio. There’s also the benefit that any certificate you receive after attending an Oxford Medical Training course is always available via your My Account section of our website.

Technology can help

“Never let a good crisis go to waste.”

Many people credit first use of this phrase to Winston Churchill. His vast body of speeches and writings have become a rich source for memorable quotes. Yet there’s no hard evidence to support the attribution in this particular case. No crackling sound recording. No hand written letter. No minutes from a late-night emergency meeting to document his use of the phrase. It does, however, sound very like the sort of thing he would say.  Does it matter? Well, for most of us, the evidence of first use of the expression is of little importance.  We are far more interested in the sentiment: that a time of crisis provides fertile conditions for significant change.

But evidence is of great importance in other contexts. The UK’s entire legal system is dependent on the burden of proof. A criminal conviction can only be secured by the existence of firm evidence. At times this can be infuriating. We feel great injustice when the perceived ‘guilty’ party walks free when the case against them collapses or when the rules have been dis-honourably applied. Evidence has to be robust, with judge and jury challenged to resolve the presence of conflicting information.

Doctors in the modern age are dedicated to the practice of evidence based medicine. This is a fairly straight-forward principle to apply when all the evidence is complimentary and pointing in one direction. However conflicting evidence creates the stress of ethical dilemma. Regardless of your specialty or field of interest, it is worth paying attention to a scenario being played out in the world of ophthalmology at present.

Pharmaceutical giants holding the NHS to ransom?

For previous generations, the onset of wet age-related macular degeneration (wet AMD) meant an inevitable loss of visual acuity. An otherwise healthy individual could expect this to have a significant detrimental impact on their quality of life. This typically meant losing the ability to drive in early stages, then ability to read or fulfill everyday tasks with the related loss of independence. The advent of anti-VGEF injections as an effective treatment or management option for many cases were therefore rightly recognised as a medical breakthrough. A few years down the line, however, and ophthamology is faced with a major headache:

• There are two drugs licensed for wet AMD treatment: Eylea produced by Bayer and Lucentis by Novartis.
• Over a decade ago another anti-VGEF drug, Avastin, was found to be as effective as Lucentis for treatment of AMD.
• Though it is widely used in the US and across the world as a treatment for wet AMD, the owners of Avastin have never applied for its license for use as an ocular treatment in the UK. Avastin is only licensed by the EMA for the treatment of cancer.
• The rites to Avastin are now owned by Roche.  Novartis hold 33% of ownership shares in Roche.
• A single treatment of Lucentis costs the NHS £700. A single treatment of Avastin costs just £70.
• An NHS funded study of 2012 concluded equitable safety and efficacy of both drugs. Estimated annual savings at that point were estimated at £84m per year. The difference is likely to increase as the average age of the population increases
• 12 NHS Clinical Commissioning Groups have therefore decided to offer all relevant patients to option of using Avastin, the cheaper drug, explaining that this will free up significant funds for other purposes.

That decision will make sense to the vast majority of readers. However, Bayer and Novartis are now considering taking legal action against the CCGs in question. It “is not in line with the current UK and EU regulatory framework, the purpose of which is, among others, to protect patients and monitor the safe appropriate use of medicines. The framework provides that unlicensed medicines can only be used where there is an unmet medical need. That is not the case here as there are two licensed products available in the UK, both of which have been approved by NICE as clinically and cost effective.”

What is the relevance to other specialties?

There is no questioning the evidence here.  Yet the collated evidence creates a conflict. Current regulations mean that the rules have to be breached in order to take the common sense approach. Pharmaceutical companies appear to be holding the NHS to ransom by evidencing regulations which were created with the best of intentions. As the financial pressures continue to take a grip of the NHS then the challenges to make the best use of the funds available are increasingly likely to lead to ethical dilemmas such as this. It leads to a few questions for consideration:

• How bad does a crisis have to get before it initiates true, fundamental change?
• Is there an equivalent scenario brewing in your own specialty?
• Could steps be taken to prevent it reaching this point?
• What can you learn from discussing the scenario with ophthalmologists and managers?
• Ophthalmologists: how could your experience benefit doctors from other specialties?

Never let a good crisis go to waste.

Stephen McGuire – Head of Development

UPDATE BMJ2018;360:k344  GMC have now stated “Where doctors work in partnership with patients, following clinical guidance , and making prescribing decisions in good faith on the basis of evidence and experience the use of Avastin would not cause us any concerns.” adding it will “not raise fitness to practise concerns” against doctor using Avastin for treatment of macular conditions.

“Quality has improved overall, but there is still too much variation and some services have deteriorated.” 

That’s the conclusion of the annual State of Care Report 2016/17 by the Care Quality Commission.  State of Care is the document which the CQC publishes to communicate its assessment of the quality of health and social care provision.  Though its responsibility is to regulate provision of service provision across England the report has relevance for doctors in all four corners of the UK.  Its unsurprising that news coverage of its publication left little to feel positive about.  BBC responded with a headline conveying deep concern: “NHS future precarious, says regulator.”  But could there be more to the State of Care Report beyond such headlines?  Let’s go back to the source and consider the key messages from the CQC’s in their own words.

The findings can be summarised via its five key points:

1: Health and care services are at full stretch.

2: Care providers are under pressure and staff resilience is not inexhaustible.

3: The quality of care across England is mostly good.

4: Quality has improved overall, but there is too much variation and some services have deteriorated.

5: To put people first, there must be more local collaboration and joined-up care.

Healthcare professionals are acutely aware that the system is at full stretch with providers under pressure.  Recognition that the quality of care is mostly good, in spite of the challenges, may surprise some and is encouraging.  Acknowledgement that there must be a limit to staff resilience will also be broadly welcomed.  However, that is of little consolation for those individuals who have already been effectively broken by unrealistic stresses and strains.  Many oare temporarily or even permanently lost to the system, adding to the stresses and strains.  Reports are of little benefit if they fail to affect the actions of those who have influence.

Its easy to see regulators as sources of perpetual, negative, fault-finding criticism.  Yet the CQC aim to provide guidance on how to improve.  For example, 2014/15 placed emphasis on the importance of medical leadership in resolving quality of care issues.  They indicate this has been an important element in the progress mentioned in point 4.  Good leadership will also be essential for resolving the reported variability and even deterioration of services in some locations.  Team members whose services are classed as “outstanding” should be rightfully proud of their performance.  Unfortunately, such rating is of little consolation to patients of the hospital or provider a few miles away where services are “inadequate”.  Which brings us to the CQCs fifth point.

To put people first, there must be local collaboration and joined-up care

Numerous job-roles, including doctors of all types, and organisations working in harmony requires significant effort.  Good leadership has already been mentioned.  True collaboration and joined-up care is dependent on excellent team communication.  Planning, organisation and implementation skills are also required along with the ability to help others learn how to participate in a complex system.

To repeat the comment from earlier: Reports are of little benefit if they fail to affect the actions of those who have influence.  The reality is that every doctor has influence and has a role in achieving local collaboration and joined-up care.  For a few, this may mean taking formal and potentially high profile leadership roles.  For the many, it is the day-to-day attitudes and actions which will lead to success success.  Developing an understanding of the system, the skills to communicate well with other teams, to take the lead when the situation requires and to implement change can all directly impacts on quality of care.

How do you see your role in developing local collaboration and joined-up care?  What steps are you taking to be able to rise to the challenge?

Stephen McGuire – Head of Development

Are you one of the many doctors applying for ST or CT interview in the near future? If so, you’ll be aware of the high rates of competition for securing your desired Specialty or Core Training post. In 2016, almost 16,000 doctors made applications for less that 9,000 ST1 and CT1 training posts in the UK.  That’s around two applicants for every available position. Competition for ST3 and ST4 posts was similarly high. In a number of cases, there were more than 8 candidates per post. At the highest level, there were a remarkable 17 applicants for each Community Sexual and Reproductive Health vacancy. The specific ratios for each post are prone to change each year and are hard to predict. The desire of each candidate to be successful, however, is constant, year after year after year.

So who is the perfect interview candidate?

A good place to start is to consider what the interview panels are looking for. They seek to answer the following questions:

• Has you acquired the basis of knowledge, skill and experience required to successfully begin the training programme?
• Do you have a realistic, proactive and flexible approach to learning required to fulfill your potential?
• Are you genuinely motivated to take on this specific role and to complete the full journey?

Of course in the real world, perfection is non-existent. Here is a more realistic thought to hold onto. You have no control over the performance of other candidates and perfection is an impossibility.

The best prepared candidates are those who know what to expect and are able to present themselves at their very best.

How do I make sure I present myself at my best?

There is a touch of irony to realise that the ‘perfect’ candidate is well aware of their imperfections – and is proactively working them! Performing to the best of your abilities at interview is directly related to your preparation.

In many ways, you have been preparing for this moment for years. You have been increasing your knowledge, skills and experience on a daily basis throughout your student and foundation years. You may also have taken on different roles and made choices which have contributed to your development. It is essential, however, to set aside some time to reflect on your experiences, skills and opinions in order to know which you want to share with your interviewers. Practicing responding to interview questions and tasks in a structured manner helps you to both build confidence and become more concise in your communication. Ensuring you proactively research the format and purpose of the various interview stations improves your alignment to the interview panel’s interests.

With this in mind, we have fully re-developed and improved both the Oxford Medical ST & CT Medical Interview Guide and the ST & CT Medical Interview Course. We use structured and interactive processes to help you achieve success through:

1. finding your own words and behaviours which will present you at your very best
2. identifying and clarifying areas for your personal development

This is how you will optimise your chances of convincing your assessors that you are in fact the perfect candidate for them.

How are you preparing for your interview?

Stephen McGuire – Head of Development

Trust between people and organisations is in crisis. An unprecedented global implosion of trust has occurred over the past year. That’s the conclusion of the 2017 Edelman Trust Barometer. This is a study into the attitudes of some 33,000 participants across 28 countries which has been conducted annually since 2000. Edelman have found that two thirds of the countries in their study are now populated by a majority of ‘distrusters’. They note that this is a significant acceleration of an ongoing trend. The UK has become one of these predominantly distrusting populations. A distrusting population is described as one where over 50% have lost trust in business, government, media and non-profit organisations – such as the NHS.

There are a multitude of drivers of this change. Everything from the 2009 financial crash and the rise of terrorism to public scandals and the ‘echo-chambers’ of social media. The symptoms are all around from the rise of fake-news to last year’s junior doctor’s strike. Peers are now considered to be as credible as experts.

What are the implications for doctors?

The symptoms of the collapse go beyond the high level trends and events. They affect our everyday social attitudes and culture with Edelman suggesting the risk of a continual downward spiral.

• Loss of trust in institutions leads to lack of belief in the system
• Lack of belief makes us more vulnerable to fears
• Fear further erodes trust
• A vicious circle of decline becomes established
• The culture of distrust grows

Strong working relationships with patients and colleagues are essential for good medical practice. To paraphrase Stephen MR Covey: Change happens at the speed of trust. Change in itself takes many forms. Successful consultations, treatments, leadership, teaching, appraisals, referral to another colleague and numerous other interactions are examples of everyday change activities. Symptoms of the trust implosion which you could experience in daily practice could be:

• the patient who is more influenced by their friend’s opinion than by your own
• team members who doubt the motives of their leaders
• the doctor who would rather “do it myself and that way I know it’s done right”
• “I won’t believe you till I see it myself”
• team members who would rather grumble than offer solutions
• the colleague who will not speak up when they see something that is wrong

So what’s the solution

Trust is, without doubt, a complex matter. We can consider it as an attitude of others or we can consider it to be a competence resulting from our personal behaviours. In the latter, we can take responsibility for the development of our own behaviours.  We can take responsibility for the frequency, quality and openness of our communication. We can ensure our actions match our words with integrity. We can create the space for and invite the opinions of others. We can choose to respond to these opinions in a constructive manner. When the time is right, we can choose to be assertive with consideration to both ourselves and others. There are many other examples. In short, the trust we receive from others is directly related to our leadership, teaching, team and patient communication skills.

If a breakdown of trust can create a vicious circle of decline and negativity, then it follows that the development of trust should lead to a virtuous circle. Such a virtuous circle will have positive impacts for our patients, our colleagues, our organisations and, ultimately, for ourselves.

What steps are you taking to foster the development of trust?

Stephen McGuire – Head of Development, Oxford Medical Training

Due to the popularity of our 1-day CPD accredited Practical Leadership & Management Course for Doctors in both London and Birmingham we have now made it available in Glasgow.  This course is designed to develop the skills required to get things done through organising people, projects and resources.  We’ve had excellent feedback from delegates who have attended this course in London and Birmingham since it was launched last year.  Independently collected reviews from previous course delegates are available for you to read on TrustPilot.  The key subjects which you will explore at this event are:

• Organising people, projects and resources
• Conducting a review and root-cause analysis
• Planning and implementation
• Time management and delegation
• Managing yourself for optimum impact

Numbers are limited to 18 delegates per course.  If you are local to Glasgow then this is an excellent opportunity to develop your skills, bolster your CV and acquire relevant CPD points.  If you are unfamiliar with this vibrant city, there are excellent travel links and plenty to see or do if you want to make an extended visit.

Click here to see available dates and to book your place.

Other courses which we regularly run in Glasgow include:

• Teach the Teacher Course for Doctors
• Consultant Interview Course
• 2-Day Advanced Communication Skills Course for Doctors
• Advanced Patient Communication Skills Course for Doctors
• Advanced Team Communication Skills Course for Doctors

We look forward to seeing you in the near future.