Engaging with the top
by Dr Aamir Saifuddin
06 August 2019
Effective engagement can be a gateway for improvement
In my previous blog ‘Leading from the frontline,’ I talked about the need for clinicians to get more involved with leadership and understand the strategic context that healthcare operates within. However, managers also have an equal responsibility to reach out to clinicians. Board members should be looking to better communicate reasons why certain decisions are made. Doctors, particularly juniors, feel like changes are ‘being done’ to them rather than feeling engaged in the process. This perpetuates how alienated they often feel from high-level decision-making and further reduces the likelihood they will engage with senior leadership teams in their trust and subsequent trusts they move to.
The HFMA qualification in healthcare business and finance has helped me to see why certain strategic decisions are made and the different local and national considerations involved. Clinicians often see managers as ‘only caring about the money,’ but the qualification has highlighted why these financial considerations are so important. However, senior leaders need to reach out to frontline staff and help them to understand the rationale. Given the unpredictable working days of junior doctors, managers need to go out to them on the wards, rather than expecting medics to approach them. Lunchtime or afternoon engagement sessions, for instance, are organised with the best of intentions. However, they are often very difficult to attend: a patient may become acutely unwell, the ward may be short-staffed, a patient’s relative may want to speak to someone urgently, or the doctor may get ‘bleeped away’ halfway through. Instead, managers are much more likely to meet doctors by seeking them out within the hospital, where I think they’d be pleasantly surprised by the interest they show in non-clinical issues, the ideas they have for improvement and how much they appreciate trust leaders ‘reaching-out’ and listening to their invaluable opinions and perspectives; this needs to be harnessed. Many of my fellow learners on the qualification have been managers, which has made me appreciate the different views and skillsets they possess and consider how effective a more joined-up approach would be.
Early clinical input would also help board members to better frame communications about the changes they propose from a clinical and patient safety-centred perspective. This will ultimately help to get other clinicians on-board who can then continue to cascade the message across the hospital and the trust. This takes a significant amount of effort from all parties but would improve morale, with clinicians understanding the rationale for changes rather than feeling like passive bystanders. It may also inspire junior doctors to get more involved in managerial or strategic roles
In a previous trust, I was asked by a senior matron how they could improve the disconnect between managers and clinicians. I explained that no-one had even seen the board members in-person. As a result of this conversation, we arranged a ward walkaround with the Chief Executive, Deputy Chief Executive and Chair to meet junior doctors so they could hear about the issues affecting day-to-day work, patient flow and safety. This led to a number of junior doctor-specific projects, such as the development of safe weekend handover systems, becoming trust priorities and the ward visits becoming routine.
I currently chair my trust’s Junior Doctor Service Improvement Board and I hope to work on more quality improvement projects during the rest of my specialist training and beyond. I hope to be a consultant at a trust with a great culture for change, where new ideas and innovative opportunities are embraced and facilitated, rather than dismissed.
The label of ‘leadership and management’ can have negative connotations among clinicians, but it is crucial that this culture changes. I believe that the best results can only be obtained by harnessing the skills, expertise and visions of both managers and clinicians. But this will take a change in mindset from both sides, the first step of which is shared engagement at a local level.
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