Teaching and Training on Ward Rounds
Over the past number of weeks I have been experimenting with a new teaching/training technique. I select an appropriate review patient for the F1 or F2 to review while I fulfil the support role of writing in the notes and making the obs chart, kardex and fluid balance available.
Before going to see the patient I ask the F1/2 to read the previous entries in the notes and consider some key questions: what are the issues for this patient? How ‘unwell’ are they? What outcome are we trying to achieve for this patient? Do they need further inpatient stay or are they ready for discharge? If we are thinking of discharge, what are the risks and how do we manage/mitigate those? What information do we want to find out from the patient? What key information do we need to give to the patient?
After having an opportunity to think about this I observe the F1/2 carrying out the encounter with the patient and afterwards I ask them questions about what went well, what they could have done better, what they would do differently next time etc. And finally I try to provide some constructive feedback and suggestions to help them in future.
The F1s and F2s seem to like this and find it valuable. The only downside for me is being bombarded with ePortfolio assessment requests that evening!
There is a thin line between service delivery and training. Clinical knowledge is not enough to make a safe, competent doctor who delivers a quality service patients are satisfied with. The mix of skills, attitudes and behaviours required is far more complex and nuanced and can only be truly experienced, learnt and practised by being immersed in service delivery. Therefore, I believe the key to maximising learning and training is to have a learning focus in the service delivery environment. The ward round is a key opportunity for this.
Medical Leadership Symposium 2013
This week I have been quite busy organising the 3rd annual Northern Ireland Medical Leadership Symposium which will be held on Friday 21 June 2013. I ran the first event in 2011 because I felt we in Northern Ireland were missing out on opportunities for promoting and developing medical leadership by not having enough events and opportunities where existing and aspiring medical leaders could come together to network, learn and share ideas.
I thought an annual conference would be the ideal way to create a buzz around medical leadership by providing a focal point and highlight in the annual medical leadership calendar.
The success of the second event in 2012 exceeded my expectations to the extent that the venue was busting at the seams, so this year I decided to take a risk and move to a much bigger and grander venue – the Titanic Suite at the iconic Titanic Belfast.
The dedicated event website will soon go live at www.medleadsymposium.co.uk but in the meantime you can keep up to date with the symposium by following @MedLeadSymp on Twitter or Medical Leadership Symposium on Facebook. The hashtag for the event is #mls13.
Leadership Breakfast Seminar with Professor John Higgins
On Thursday morning I attended a breakfast seminar at the HSC Leadership Centre with Professor John Higgins, Head of College of Medicine & Health, University College Cork, and Chair of the Strategic Group, Hospital Group Strategic Board.
Prof Higgins recounted his experience of leading major change to reconfigure hospital maternity services with the amalgamation of three maternity hospitals to form the new state-of-the-art Cork University Maternity Hospital.
The key take-home message was no surprise. The change had been successful due to successful communication and engagement, both with the public and with health service staff. But what was interesting was Prof Higgins’ explanation about the extent of communication and engagement required, how they did it, and the lengths they went to.
He advocated strong clinical leadership and using clinicians instead of officials to communicate and engage with the public because the public trust clinicians and don’t trust officials. He told how the population in an area were concerned about closure of their local hospital and whether patients would have worse outcomes because of the travel time to the nearest hospital. In order to allay these concerns they took two of the new ‘advanced paramedics’ to countless meetings with members of the public. The paramedics were able to explain how they would stabilise and care for patients en route to the new hospital, sometimes in great detail in response to specific scenarios put to them. They also explained why it was best to take a patient to the right hospital, not just the nearest one. This method of communication was hugely successful and Prof Higgins showed press clippings that demonstrated the change in public mood – from protesting against the loss of the local hospital, to celebrating the gain of advanced paramedic crews.
Prof Higgins also highlighted the importance of fully engaging staff to implement successful change. The lesson here was – communicate until the cows come home. Keep going to meet and speak to clinicians, and keep answering their questions until they have none left. He gave an example of communicating to a resistant group of GPs who kept requesting meetings to voice their concerns. In the end he was offering them further meeting and they were saying no, because they had finally accepted the case for change.
The final message was – the public are interested in what you do, not what you promise, so they will judge you on what they see. They will know intuitively if you’ve got it right. When they walk into a hospital they will know if it’s a good one, just like you know when you’ve walked into a good hotel.
If you are trying to lead change and find people resistant and not engaging – do not blame them. Your job as a leader is to engage them. That’s your job and your responsibility. Don’t make excuses about your efforts at engagement not being successful because people weren’t interested. Find a way to get them interested. Find out which channels people prefer to receive communication through.
If you want your change to be successful you need to take responsibility for engagement – do not transfer it onto those you need to engage, because if you do this all you will have is a good excuse for failure. What you want is success. So keep your eyes on the goal and take responsibility for engagement.
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