Building a resilient, clinically led Trust'

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Building a resilient, clinically led Trust.

• Dr Emyr Wyn Jones DM FRCP
• Consultant Physician and Medical Director
• Doncaster and Bassetlaw Hospitals NHS Foundation
  Trust
• Chair - BAMM

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http//www.dbh.nhs.uk
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The Foundation Trust still needs to earn its
keep.
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Medical manager - Individual success and
Corporate success

• If your organisation fails you fail.
• Success in the NHS market depends on attracting
  income and on controlling expenditure by driving
  down inefficiencies. So, income meets/exceeds
  expenditure
• Success in the NHS market depends on attracting
  activity/income through marketing
• In the NHS market, competition is based on
  quality not on price. Financial gains are made
  through efficiencies.
• Quality effectiveness efficiency

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Medical Professionalism

• A set of values, behaviours and relationships
  that underpin the trust the public has in
  doctors.
• Doctors in Society
• Report of a Working Party of the Royal College of
  Physicians of London. (2005)

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Medical Profession - one mans view

• Medicine is not a lucrative profession it is a
  divine one
• John Coatley Lettsom
• (1744 -1815)

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Doncaster and Bassetlaw Hospitals NHS Foundation
Trust
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Doctors

• Are motivated to do the best they can
• Are trained to do things scientifically and
  respond to data
• Enjoy intellectual challenge and will debate
  readily
• Prize clinical autonomy

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Doctors

• Respect expertise and value its acknowledgement
• Tend to disengage if they feel their time is
  being wasted
• May seek additional information in order to
  eliminate any risk
• May focus on the immediate single issue rather
  than wider future perspectives

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The Primacy of the Doctor-Patient relationship

• The duties of a doctor registered with the
  General Medical Council
• Patients must be able to trust doctors with their
  lives and well-being. To justify that trust, we
  as a profession have a duty to maintain a good
  standard of practice and care and to show respect
  for human life. In particular as a doctor you
  must..
• Make the care of your patient your first concern

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Doctor in management - the compromise

• Recognising that a doctors duty is not just to
  the patient sitting in front of them but also to
  all the patients who use the service.
• This is especially true in a service which is
  funded from the public purse, available to all of
  the public and accountable to the public through
  its elected representatives.

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Corporacy - definition

• Of, or shared by, a whole group, not just an
  individual
• Cambridge International Dictionary

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The consultants corporate self

• Clinical firm
• Medical Specialty
• Multi-disciplinary Team
• Directorate
• Trust
• Health community/Clinical Network
• NHS

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Why develop clinical leaders?

• GMC Good Medical Practice places appropriate
  emphasis on both
• Working in teams
• and
• Leading teams

Doncaster and Bassetlaw Hospitals NHS Foundation
Trust
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The Challenge of Leadership

• An army is likely to be only as good as its
  higher commanders whose job it is to ensure that
  the doctrine, organisation and equipment are
  appropriate and in harmony
• Army Doctrine The Approach to Command.

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Doctors in Management Owning the business

• What skills are required from clinicians who
  aspire to become service line leaders?
• What are the personal challenges of running a
  service line as a business?

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Doctors in Management Owning the business - 2

• Can clinicians ever reconcile the demands of
  professional practice with the demands of being a
  business leader?
• Do compromises need to be made? If so, what are
  they?

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Medical manager the bad bits

• Being identified as one of them
• Seeing the imperfections
• - Badly behaving doctors.
• - Poorly performing doctors.
• - Less than perfect care.
• - Inappropriate use of resources.
• Workload too much work and not enough time or
  support.

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Challenges for the Medical manager - 1

• Change is always resisted except by those who
  clearly see the benefit of the change.
• For a team to succeed in the long run it must be
  working within a supportive organisation.

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Challenges for the Medical manager - 2

• Differences and diversity coming into Health
  Services are bound to cause reverberations.
• There is an implicit understanding that
  introduction of reforms such as Introduction of
  Plurality, PbR, Choice and establishment of
  Foundation Trusts will lead to structural change
  in health services

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Skills required of medical managers

• Clinician
• Teacher
• Mentor
• Team leader
• Team player
• Planner

• General Manager
• Personnel Manager
• Accountant
• Estates manager
• Salesman
• Strategist

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Andlearning a new language

• contribution to cash-releasing cost improvement
  targets greater diversity and plurality of
  services. more responsive to commissioner
  requirements managed according to transparent,
  common standards. inspected and regulated
  against

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How to Achieve Partnership and Influence

• Deliver on promises
• Really listen to the issues being raised
• Understand the professional groups
• Dont waste their time
• Ask their advice listen to what they say
• Provide a vision of success
• Treat the past with respect
• Keep the communication flowing

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Management of Change

• Turn weaknesses into strengths
• Turn threats into opportunities
• Think out of the box - Problems cannot be solved
  by thinking within the framework in which the
  problems were created (- Albert Einstein).
• Stay optimistic!!
• Keep talking

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Clinical Leaders does power corrupt?

• It is not power that corrupts but fear. The
  fear of losing power corrupts those who wield it
• Aung San
  Sui Kyi

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Qualities of the best leaders

• The most successful leaders in industry
• Inspire high standards
• Are intolerant of mediocrity
• Have an iron will but personal humility.
• Plan a reliable succession.
• Look out of the window to apportion credit.
  Look in the mirror to assign responsibilities

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What fosters Clinician Engagement in the
Management Process?

• Trust
• Integrity
• Credibility
• Communication
• Information
• Involvement
• Ownership

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Clinical Engagement

• Out of clutter find simplicity
• From discord find harmony
• In the middle of difficulty lies opportunity
• Albert Einstein

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How to get Clinicians on Board

• Measures of performance must be credible
  evidence based and valid.
• Physician leaders must sit at the table with
  non-physician leaders.
• Physicians must be persuaded of the correlation
  between best clinical practice, clinical efficacy
  and cost effectiveness.
• And that investment in information systems
  correlates with improved clinical quality.

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The importance of credible clinical information

• Robust, timely and accurate information on
  clinical performance and outcomes is essential
• For individual and team performance monitoring
  (Appraisal)
• For monitoring clinical effectiveness and safety
  (Clinical Audit).
• For securing income (Payment by Results)
• For contestability (marketing based on access and
  quality standards).

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Thank you very much
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And remember

• Learning is not knowledge
• Knowledge is not wisdom
• Wisdom is not truth
• Truth is not love
• Love is not beauty
• Beauty is not music
• Music is all
• Frank
  Zappa

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