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Hot on the heels of last week’s headline grabbing story regarding the new website which, as part of its brief, will name and shame NHS Trusts which have been rated poor for honesty and openness, Health Secretary Jeremy Hunt has gone on record to state that he wants to expose doctors whose failure to spot cancer may delay sending patients for potentially life-saving scans.

Naming and shaming is undoubtedly an NHS Hot Topic at present and therefore likely to be the subject of medical interview questions.  When asked a question on any topic, an effective answer conveys the correct factual information that is then used to convey a reasonable opinion.

But is naming and shaming only an issue for the top line of NHS leadership and management?

In his powerful lecture “Doctors make mistakes. Can we talk about that?” Dr Brian Goldman makes a very persuasive argument that the approach to errors is a piece of medical culture that has to change at all levels.  He discusses the messages which are ingrained from the earliest stages of being a medical student: “Be perfect; never, ever make a mistake”.  He describes his feelings of being alone, isolated and of shame when a mistake has been made.  He highlights that there are two kinds of physicians: those who make mistakes and those who don’t, those who can handle sleep deprivation and those who can’t.  He then goes on to describe what he calls the “redefined physician” who “is human, knows she’s human, accepts it … and she works in a culture of medicine that acknowledges that human beings run the system.”

Such an understanding, supportive, learning culture is quite different from both the naming and shaming world and the other unpalatable alternative where mistakes are hidden, denied and ignored.

Culture is something which has to be grown, nurtured and cultivated which depends upon deliberate acts of leadership and management.  The Healthcare Leadership Model states very clearly that these acts are not only for those who have the title of leader or manager.  Going back to Dr Brian Goldman, “it starts with one physician – and that’s me”.

Where do you stand on the naming and shaming approach to managing the NHS?

The topic of appraisal, particularly in relation to revalidation, has been a focus of discussion at the British Medical Association’s Annual Representative Meeting this week.

Although doctors were keen to stress that they had welcomed and embraced what they believed would be a valuable process, which would make better doctors and benefit patients, the report on BMA news relays numerous negative comments.  Appraisal has become “burdensome”, “too time consuming”, “hijacked and made part of revalidation”, and is “no longer meaningful”.  There are “hoops to jump through and boxes to tick”, plus the process takes “both appraisee and appraiser away from spending time with patients”.  One delegate even told of his personal experience where his recent appraisal “found he had not reflected enough, nor reflected enough on his reflection.”  His summary stated “It’s not what we signed up for and it’s not what we developed.”

This final quote in particular begs the question:  Is it the principle or the implementation which is at fault?

There are responsibilities all round here, from the Responsible Officer developing and maintaining the appropriate culture, supported by effective processes, through to the appraisee adopting a positive approach to the process.  The initial and ongoing training of appraisers has to be a critical factor here.

The GMC’s revalidation requirements for doctors are dependent upon sufficient numbers of medical appraisers to be trained to a high and consistent standard in order to ensure a robust, effective process.  Before being absorbed into NHS England, the NHS Revalidation Support Team emphasised  in their document Quality Assurance of Medical Appraisers (Version 5: January 2014, that all medical appraisers “should demonstrate the same level of core competencies, so training programmes should be based on a strong core of material”.  In addition, doctors who work as medical appraisers are required to undertake continued professional development in this area, keeping up to date, enhancing skills and calibrating practice with other appraisers.

These are positive statements, which the RST has backed up by making outline training materials available.  However, to avoid appraisal and revalidation descending into the reported hoop jumping, box ticking, pointless exercise, it is essential that Responsible Officers ensure that quality appraiser training be delivered by expert facilitators.  This applies to both the initial training and to the ongoing improvement.

Can the current appraisal/revalidation system be implemented in a way which will achieve the intended goal of making better doctors and benefitting patients?  Or do we need a major rethink?

Satisfaction with the NHS in Scotland has increased significantly in the last decade, research suggests.

According to an official survey of almost 1,500 members of the public (rather than patients), satisfaction with the NHS in Scotland has increased significantly in the last decade.  61% of those polled were either very or quite satisfied with the health service, compared with 40% in 2005.

Scottish Health Secretary, Alex Neil, attributed the findings to increased NHS staffing and a reduction in waiting times.

The statistics, the latest to be released from the Scottish Social Attitudes Survey 2013, were collected between June and October last year. The findings in Scotland outperform the latest findings in the rest of the UK. The British Social Attitudes survey collected results from June to September 2013 and found satisfaction to be the same as 2012 at 60% compared to a high of 70% in 2011. Attitudes towards the NHS are on a high with the last decade showing an improving trend for the whole of the UK, from a low of 38% in 2001 to 60% today. In only two of the past 30 years (2009 and 2010) have satisfaction levels been greater than those recorded in 2012 and 2013. Read a full report here.

At Oxford Medical, satisfaction with our own services is just as important. We regularly monitor, and act upon, feedback from doctors who attend our courses. If you’ve been to one of our courses, or purchased distance learning or guides online you can now contribute by posting a review about your experience on the independent review site Trustpilot.

If you’re thinking about attending a course why not see what others are saying about Oxford Medical and our services first?

One of the main recommendations of the Francis report into the failings at Stafford hospital was that all hospital patients should know the name of the senior doctor in charge of their care. They should also know the name of a nurse who can answer their questions. The Academy of Medical Royal Colleges published its advice last week in a document called Accountable Clinicians and Informed Patients but what does it offer beyond “names above a bed”?

The guidance is meant to improve both accountability of clinicians and communication with patients and families. Successful implementation addresses both aspects. The Responsible Consultant/Clinician takes overall responsibility for the management, coordination and continuity of a patient’s care. They work with a multidisciplinary team but retain overall responsibility for the management decisions for that patient, including discharge. The Responsible Consultant/Clinician is also expected to have some direct personal clinical responsibility and contact with the patient. In addition, patients will have a Named Nurse who they can ask for immediate information. The Responsible Consultant/Clinician should remain the same throughout the patient’s hospital stay. The Named Nurse is changed with each shift.

Knowing who to approach with questions empowers patients and relatives to understand and get involved in their care. Knowing who to approach with their concerns is likely to ensure that any issues or concerns are resolved promptly and appropriately.

Oxford Medical runs regular training in communication skills and management skills throughout the UK.

At this time of year, many of us will be turning our attention to holiday planning.  After the initial thoughts about where and when to enjoy a well end break, the question which inevitably follows has to be: What happens when I’m away?
For some reason, there has been a recent flurry of comment on discussion boards regarding a story which first surfaced in September 2013 regarding a survey which concluded “one in eight GPs admit letting receptionists decide which patients need appointments”.  Exactly what has triggered this particular story to come back into focus is not clear.  What is clear is that there is a broad range of views over what is appropriate to delegate and to whom.
I’m sure that we have all at some point been on the receiving end of a workload dropping on us from on high with minimal support or follow up.  At times, the tasks we have been given may have been beyond our abilities, either in the quantity or for our competence at that stage.  Sometimes we sink, sometimes we swim.  There are obvious risks and there is a world of difference between genuine delegation and uncontrolled abdication.
Effective delegation is a key skill within medical leadership and management which doctors must learn to master from the very earliest stages of their career.  It increases in importance as progress is made toward consultant and medical director levels.  It is a skill which has to be studied, understood and practised for improvement.  Consideration has to be given to both “who is the best for the job” and “who is the job best for”.  Processes require clarification and there must be consideration given to communication – both to the person being allocated the task and to others who will need to be aware.
So, how is your holiday planning progressing?  How is your delegation planning progressing?

Ongoing improvement to the care and experience of both patients and their families is of utmost importance to everyone involved in healthcare – but how?  Anything which helps us to answer that question must be applauded and an excellent example has arrived this week in the shape of the Patient and Family Centred Care Toolkit, courtesy of The King’s Fund.  One of the tools advocated is the practice of “shadowing”: basically the observation and recording of each step of a patient or families experience, then using this as a catalyst for change.

Having had first-hand experience of this practice – both in the role of observer and the observed – I would strongly advocate its benefit to anyone involved in an NHS leadership role.  You undoubtedly learn from the opportunity to observe colleagues in action with patients.  The detached position enables the stimulation and crystallisation of ideas regarding what needs to change.  There is also much to be gained by the colleague being observed.  Firstly, a heightened self-awareness is inevitable when you are in the spotlight, with conscious recognition of what often happens automatically.  Secondly, it provides an excellent opening for learning through feedback.

All sounds good?  Yet there is an unmentioned, essential requirement that must be considered to ensure any such exercise is a success: the need for excellent communication skills for those involved.  To begin with, any doctor who wants to initiate a shadowing exercise should expect to face a degree of resistance and is likely to need to influence others to overcome this.  Just like influencing, the ability to give genuinely useful feedback to colleagues, while avoiding or addressing any resulting conflict is another skill which must be developed and practiced.

When combined with constructive feedback and supportive challenge, the practise of shadowing is a very powerful tool to improving patient and family centred care.  To enable this, the continued advancement of communication skills for doctors with their teams has to be a priority.

How much have you changed over the past 10 years?  How much do you expect to change in the next 10?  According to Harvard Psychologist Dan Gilbert’s new six minute talk on TED the Psychology of Your Future Self, we all vastly underestimate how different we will be in the future, but readily recognise the transformations we have already experienced.  This, he explains, has to do with our ease of remembering, versus our difficulty in imagining.  We mistakenly think that because it’s hard to imagine, it’s not likely to happen and this has significant implications for the decisions we make.

So what would we do differently if we had a greater expectation of change to our careers, our working environments, and our ways of working?  We know from experience that precise long term predictions of “the way things will be” are likely to be wide of the mark.  What we can predicted with confidence, however, is that change will happen; that we will need to be at our best to deal with the unknown obstacles as and when they appear and that the more we develop our skills today, the better our best will be.

Any candidate who presents themselves at an interview with a long track record of proactive personal development is always likely to impress.  The interview panel will be drawn to any doctor who can demonstrate that a positive learning attitude is an imbedded part of their personality.  Such a candidate is far more likely to be able to give compelling examples of situations where they have put their learning into action, dealing effectively with the hurdles which got in the way of progress.

Whatever the future holds, our medical leadership, management and communication skills will need to be at their best.  Taking Dan Gilbert’s thinking on board, the time to take action to drive our development is always now.  How much change do you expect to undergo over the next 10 years?  What will you do about that today?

With this week’s headline grabbing news story, it would be safe to assume that every doctor will now know the name of NHS England’s new Chief Executive.  In his high profile interview in the Daily Telegraph, Simon Stevens, outlined his opinion that the NHS is at a defining moment, why he took at 10 per cent pay cut to lead the NHS and, most controversially, his belief in the importance of smaller community hospitals.

So what does this actually mean?  Is this a complete volte face for the development of services back to a previous time?  Alternatively, is it a progression and natural evolution to something new; something which could not happen without the centralisation approach of recent times?  What are the implications to the organisational and financial structures of the NHS?  What do patients’ actually want?  Does that matter?  After all, to quote Henry Ford:  “”If I had asked people what they wanted, they would have said faster horses!”

Any doctor who is seeking a new consultant position and preparing themselves for interview would do well to consider such questions.  On our Consultant Interview Courses, we explore such hot topics in depth, emphasising the importance of both knowing the facts and being able to convey a considered opinion.  Consultants are expected to be leaders with influence and this ability must be demonstrated to the interview panel.  In order to express a relevant opinion on any topic, the facts must be known, the potentially conflicting views of all stakeholders understood and you must be able to clearly explain your thoughts.  This takes dedicated effort and it is best to set aside time for effective preparation.

So what do you think about Simon Stevens recent statements regarding the role of smaller community hospitals?  Why do you think that?

“Trust your doctor, not Wikipedia” is the headline on a report on the BBC News website’s Health section.  This story focuses on the output of a paper published in The Journal of the American Osteopathic Association.  It states that there are fundamental problems with nine out of 10 of the online encyclopaedia’s health entries.  The information, all of which can be edited by anyone, made statements which contradicted latest medical research.  With Wikipedia being the sixth most popular site on the internet, this clearly poses a high risk of misinformation for any patient who prefers to do their own research than to “trouble their doctor”.
This risk to patients is the key focus of the BBC report.  However, there is one short statement which any doctor involved in the teaching, support and development of others should take time to consider:  Up to 70% of physicians and medical students use Wikipedia.
There are many potential sources of incorrect or outdated information for learners in medicine.  The ongoing, progression of discovery will always mean that knowledge and best practice must continually be updated.  As a result, the papers which were at one time considered essential reading are naturally superceded.  They do not, however, cease to exist.
Students will often go “off-piste” from any reference lists which are fed to them.  The end result of such self-directed exploration can be greatly enhanced learning.  Alternatively, it could lead to disastrous misinformation.  On our Teach the Teacher Course for Doctors we discuss the importance of the teacher understanding where the learners in their care are accessing information.  Once we establish the importance, we discuss how the teacher can achieve such understanding.
It is paramount that our developing doctors are growing their knowledge from reliable, up to date, peer reviewed materials.  Many of us diligently create an “Essential Reading List” for guidance.  How many of us create “A Don’t Read List” to steer learners away from Wikipedia; from the outdated and from the discredited?  Should we?