Eight years ago I was cleaning out my office prior to taking up post in NHS Ayrshire and Arran as Associate Medical Director. I came across a letter written 10 years earlier by a bolshie young consultant criticising some new development. I will come back to that letter later on but first I want to reflect on clinician engagement.
Medical engagement
I have been thinking about medical engagement since attending an event earlier this month organised by our Medical Director, Alison Graham. 
Research by the Kings Fund has shown that improved medical engagement is associated with improved performance and the meeting was looking at the recent Kings Fund report on four Trusts with high levels of engagement.
This is turn made me think of the HIS report on Grampian Health Board and the vivid descriptions it contained of poor medical engagement.
o http://www.healthcareimprovementscotland.org/HIS
o It’s worth quoting some extracts from the report from Grampian, not because the situation they describe is exceptional, but because it describes elements that we will all probably recognise.
‘One clinical director told us they felt there was not a lot of interaction with executive management. They assume everyone has the knowledge to do their job. The clinical director told us there was no development or support for their role. Clinical director group meetings had felt very one sided and more like a team brief led by the medical director. A clinical director and a clinical nurse manager told us they felt there was a reliance on staff at their level just to get on and do the right thing without being guided or led. The clinical director said they had been given no idea from higher management of how they were performing. The clinical nurse manager told us that they felt out of their depth and swamped at times. They had little or no support from their line manager and no formal one to ones and said this was not because the line manager was disinterested, but because they were too busy and stressed in their role. Both clinical and managerial staff complained of frequent restructuring and movement of junior managers as soon as they became familiar with an area’.
I did most of the talking
I think back to the Clinical Directors meeting that I chaired last week and reflect that I did most of the talking and wondered if my Clinical Directors also found interactions one sided at times.
We are just restarting a development programme for our Clinical Directors in NHS Ayrshire and Arran and this is partly in response to Clinical Directors desire for development. This is a start but I know that in an ideal world we would be engaging, training and developing Consultants when they take up post long before they became Clinical Directors.
It’s not unusual for someone to make a comment such as, ‘I know you are busy and I don’t like to bother you…’. Usually I am glad they did but wonder if others are not bothering me and whether a disconnect will develop at some stage between the management teams that I am part of and the services on the ground.
Leadership walk rounds – minimising the risk
‘One senior charge nurse in a ward told us that on the rare occasion that there had been a leadership walkround, they had been told by senior management to bring extra staff in to ensure that the chief executive saw there was enough staff on the ward’.
Leadership walkrounds are intended to minimise the risk of a disconnect yet in Grampian there appears in some areas to have been a culture to cover up issues rather than using leadership walkrounds as a way of seeing what was actually going on. There were similar descriptions in te Francis report on Mid-Staffordshire that described a culture where managers presented information to cover up rather than expose problems.
‘Behaviours of consultants in some ……mortality and morbidity meetings were reported to be particularly unprofessional and aggressive on occasions. Some staff had reported that they had left the meetings or others had been asked to leave due to the aggressive nature of the behaviours. Some staff also told us that they did not believe these meetings were multidisciplinary or inclusive. As a consequence, not all appropriate staff attended these meetings’. ‘Staff ……cited examples of inappropriate behaviour, including questioning of clinical decisions and rudeness being displayed in front of staff, including trainees and patients in some instances. Patients had on occasion then complained to ward staff about the behaviour of some consultants’.
Safe, Caring,Respectful and Engaged
I think back to that letter from that bolshie consultant all those years ago which was aggressive and critical in its tone. It was of course written by myself. 
Sitting in my office eight years ago thinking, how did I end up as an Associate Medical Director, I recognised that this letter was probably the start of the journey.
I was fortunate enough to have a medical manger who recognised the letter as a request to be engaged rather than just another letter from a ‘difficult’ Consultant. She invited me to Chair a working group to review the proposals. The developments that resulted have come and gone but I am still in medical management and, on a good day, I think that I can still make a difference.
Engaging clinicians remains a challenge and the commitment of both clinicians and managers is required if we are to be successful. Maybe our core values should be Safe, Caring,Respectful and Engaged.
This week’s blog was by @johntaylorpsy (Dr John Taylor), Associate Medical Director, Mental Health Services, NHS Ayrshire & Arran.
[…] the excellent posts for week 8, two caught my eye immediately. First, Dr John Taylor’s A bolshie young consultant which instantly conjured up for me the kind of confidence we have/had when young that enables us […]
By: Lost magic and bolshie traits | weeklyblogclub on March 24, 2015
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