What does good Hospital at Night leadership looks like?

1
What does good Hospital at Night leadership
looks like?

• Wendy Reid
• National Clinical Lead Hospital at Night

2
What is an effective team?

• 90 of the NHS workforce believe they are in
  teams
• Less than 50 meet the true definition of teams
• Pseudo team are more a risk than no teams at all
• The higher staff in teams lower mortality
• West

3
Well structured v pseudo teams

• Well structured Teams
• Clear objectives
• Interdependent working
• Meet (handover) regularly
• Discuss effectiveness (outcomes)

• Pseudo teams
• Higher reported errors
• Higher stress
• Lower innovation
• The illusion of inter-professional team work may
  be placing patients staff at risk

4
Leadership of Teams

• Requires training development
• Empowerment
• Authority
• Not always the most senior role/profession
• Programme developed with AoMRC IHI
• Focus on managing the team not the individuals

5
H_at_N 2008Evidence
6
(No Transcript)
7
Teams need leaders? Or followers?

• Followers
• Required in all groups
• Provide commitment, focus legitimacy to leader
• Identify with leader and allow power
• Accord or withdraw support to leaders

• Leaders
• unique to most groups
• Authority to deviate and innovate
• Guide followers to solutions
• Protect, support and provide charisma to teams

8
What should be considered?

• Ask are your teams effective well formed or
  pseudo-teams?
• Have they clear objectives?
• Meet (handover) regularly?
• Members interdependent on each other?
• Discuss (? Measure) their effectiveness
  (outcomes?)
• Are you focussing on individual members or
  managing the team?

9
Leadership is not an inherited gene?

• Leadership is not inherit training required
• Teams needs to be developed
• Members skills
• Teams managed
• Focus on output
• Leadership of H_at_N or other teams does not always
  have to be by doctors. Focus on the right team
  leader!

10
Teamwork?

• We trained hard, but it seems that every time we
  were beginning to form into team we would be
  reorganised. I was to learn, later in life, that
  we tend to meet any situation by reorganising.
  And what a wonderful method it can be for
  creating the illusion of progress while producing
  confusion, inefficiency and demoralisation
• Petronius 210 BC

11
Handover only Medical SHOs and SpRs (plt0.001)
None Informal A phone call or email An organised meeting doctors An organised meeting doctors nurses
No H_at_N No.4137 1 40 5 31 22
H_at_N No.506 2 23 6 21 49
12
Handover only Medical SHOs and SpRs (plt0.001)
None Informal A phone call or email An organised meeting doctors An organised meeting doctors nurses
No H_at_N No.4137 1 40 5 31 22
H_at_N No.506 2 23 6 21 49
13
Case Study 1

• Urban District General Hospital
• Transient population
• Predominately elderly medical care needs
• Poor transport infrastructure

14
Surgical Wards Cardiac Arrest Data
Reduction of 56
Total 04 33
Total 05 12
15
Cardiac Arrests 2004 n105 2005 n 75
29 drop
16
Case Study 2

• Large teaching hospital in London
• Implementing an out of hours critical care
  outreach service

17
Readmission and post-ICU death rate
PERT starts
18
1192 adm/yr
1173 adm/yr
16
1304 adm/yr
1152 adm/yr
14
12
10
121 pts
of admissions
113 pts
118 pts
105 pts
8
6
1st 5 m 23.5
4
2
0
2001
2002
2003
2004
2005
Avg readmission rate
Avg. post ICU death rate for year