Each weekend I will reflect back on the working week and post some observations and thoughts.  I hope you find it interesting!

Chief Executive & CMO Visit

On Monday the Trust Chief Executive and the Chief Medical Officer visited the acute medicine unit at the RVH.  This follows the Minister’s announcement last week that he was relaxing the special measures on Belfast Trust due to the progress made in addressing 12-hour breaches in the ED.  It was good to see them there.  I strongly believe that symbolism is a big part of leadership and that you can’t lead people who don’t even know who you are.  That’s why I think it’s great to see so many CEOs around the UK actively tweeting and some even blogging too.  This makes them visible and accessible, and that’s an important part of being a leader.  I would love to see our local Trust Chief Executives and other healthcare leaders here in Northern Ireland following in their footsteps.  Last time I checked none of them were actively tweeting or blogging but I hope that changes soon.

The Privilege of Being a Doctor

On Tuesday, while supervising one of our SHOs performing a lumbar puncture, I reflected on the privilege of being a Doctor.  It’s not that I don’t already know it’s a privilege, but on this occasion, standing back and supervising, I saw a perfect example of this privilege in action.  The SHO explained about the procedure and obtained informed consent, and the patient willingly followed instructions to assume the curled-up position necessary for the procedure.  She didn’t hesitate for a moment.  She allowed another person, pretty much the same age as her to push a needle through her skin, through ligaments, through a space between her spinous processes, and into the fluid that surrounds her brain and spinal cord.  And when it wasn’t successful the first time she allowed further attempts.  This is why it’s so important to uphold trust in the profession as a whole, because this allows patients to put their trust and faith in doctors, all doctors, and to allow a person they’ve never met before to push a needle into their back.  There aren’t many other strangers that people will unquestioningly undress in front of, allow to have physical contact with them, tell intimate information to, and allow to perform invasive procedures on their body.  It really is an amazing phenomenon.  And it reminds me what a privilege it is to be a member of the medical profession.

Transforming Your Care – Future, Engage, Deliver

On Friday afternoon my colleagues and I met with Mr John Compton, Chief Executive of the Health & Social Care Board, to update him on our area of work.  I’ve never met him personally before except for being present at occasions where he was speaking.  What struck me during the meeting was his belief in, and focus on, the vision he and his team set out in Transforming Your Care (TYC).  He is able to tie priorities and objectives from diverse areas of work into this vision of the future.  He wants to know how every individual, team, department, and organisation can contribute to delivering this vision.  It brought to mind the Future-Engage-Deliver model I heard Steve Radcliffe speak about at the FMLM Conference in October.

In my opinion the whole TYC process has been handled impeccably well and is a good case study for Heifitz’s Adaptive Challenge model and Steve Radcliffe’s Future-Engage-Deliver model.  The ripening issue was the need to modernise health & social care due to the projected shortfall in the health budget and the inability to secure more money in the block grant from Westminster due to austerity measures.  The Health Minister asked Mr Compton to lead a team carrying out an urgent review of health and social care in a short timescale.  The review included a large amount of stakeholder engagement and crucially, a communication strategy which raised the level of distress by explaining to the public what the problem was, what change was needed, and what would happen if we did nothing.  The result was widespread acceptance of the need for change.  Then came the TYC Report – the vision for the Future was laid out.  And because the case for change had been made well in advance there was little dissent.  Now we’re in the consultation period following publication of population plans and a strategic implementation plan.  This is the Engage part.  Mr Compton and his team at the HSC Board are holding town hall meetings all over Northern Ireland to engage with and listen to the population, to further explain the vision, and to respond to concerns.  And next will be Deliver.  Once the Minister has considered the response to the consultation and decided what changes will be made, the challenge will be leading people to deliver the change, some aspects of which may be unpopular with certain people or in certain areas.  This will be the hard bit.  But given how expertly the process of change has been handled to this point I am confident the TYC vision will be delivered.  That’s why it didn’t surprise me when Prof Marcus Longley, Director of the Welsh Institute for Health and Social Care and Professor of Applied Health Policy, University of Glamorgan, told the recent IHM conference in Belfast that the TYC document was ‘a very impressive document’.  But for me it goes beyond the document.  The leadership and professionalism of those involved has been impressive.