How are you?

“Busy... I’ve had back to back meetings all morning, a long list of 18 week breaches to get in ASAP, there is a delay in outpatients and I need to sort it out now, AND the ward is really short staffed due to sickness AND It’s 3pm and I haven’t had lunch”

“Don’t get me started... My to-do list is never ending. I haven’t had lunch all week, in fact, I can’t remember the last time I had a lunch break....” etc etc...

How many of these conversations have you heard?  How many have you been a part of? The relentless re-shuffling of priorities, the crisis management, the to-do list as long as your arm...  But doesn’t it make you feel important? Being in demand is so validating; being busy shows that you are doing a good job; never eating lunch shows you are committed.  And my favourite: If you have time for twitter you clearly don’t have enough to do.

I have just finished two months working at the King’s Fund, and it has shown me a completely different way of working.

I spent the first week settling in to the new office environment, enjoying delicious lunches every day and going to events and conferences that interested me.  The next week, I started some research, but also carried on meeting inspiring and thought-provoking people, going to events and reading any blogs or articles I was curious about.  At this point I started seriously questioning whether I was actually doing anything and what the point was of me being there.  All I seemed to be doing was chatting to people and reading, and I had produced a list of women’s networks in the UK… hardly a productive two weeks.  So I started organising the new West Midlands management trainee induction session.  Luckily, this involved lots of emails, a conference call with an agenda and a load of actions for me and others involved.  Suddenly, I felt right again.  I was back on track producing something!  This is what I have been taught is valuable.  But what about reflection?  When I wasn’t asked to focus on outcomes and performance, I felt lost.  I didn’t need to be stressed to prove that I was working hard.  This attitude has been conditioned in me from a young age, through a relentless schedule of exams, applications and CVs.  I knew taking time to reflect was important in theory, I just didn’t really believe it; because I had been taken in by the myth that output is more important. 

Having said this, I hope I contributed something tangible of value to the King’s Fund team.   But the main thing I will take away from this placement is the value of reflection.  It was a luxury to have two months to step away from my general management role and I know that the reality of the job and the culture means that it is going to be difficult to prioritise reflection.  I hope that in the future when I question myself, or others question me, on the value of putting time aside to reflect and forward plan I will remember what I learnt at the King’s Fund.  Working on being reflective will lead to a better quality of outcome, help me to understand my personal impact, and to be genuine as a person; an authentic leader rather than a pace-setter.   After all, the best part of my job is connecting with others to make a difference to patient care.  Thanks to the King’s Fund team for showing me something that will enable me to do this better.

Goodbye to BMEC

My last two weeks at the Birmingham and Midland Eye Centre coincided with the first two for the new matron, who asked me what the best moment of my placement was.  My first thought was that I couldn’t possibly pick; the year went by in a blur of hard work and a never ending to-do list. But I soon realised that what all the best moments had in common. These were exceptional people.

The moments that stick out the most are when people from all staff groups came together as a team to make an immediate difference to a patient. Getting patients home after heavy snow when no taxis were available, ensuring a psychiatric patient had the multidisciplinary team around him to carry out a sight-saving operation, and developing a centre of excellence for the rare Behçet’s disease.

These are exceptional circumstances, but I also remember the daily team efforts; fast tracking patients through imaging as they had already had a long wait in A&E, sorting out early discharges so there were enough beds for new admissions, and dealing with patient complaints on the spot so they didn’t escalate.

This is not to say it is easy.  For every success there were many moments of despair, tears, anger and frustration.

I learnt so much this year from the people that were tenacious when faced with obstacles and weren’t afraid to challenge the status quo, were true to their values and never lost sight of the patient’s needs.  Everyday I learnt about courage, kindness and compassion from the little acts that come together to make up the NHS.  The health care assistant whose smile never wavered when dealing with a clinic of 50 patients that was running 2 hours late.  The secretary who calmed an anxious patient over the phone.  The junior doctor who saw a few extra patients in A&E because it was busy.  The manager who spent time on the front line finding out what the problems were and then did something about it.  The consultant who embraced clinical leadership and inspired the team to improve a service.  The allied health professional who calmed a patient too scared to ask the consultant that last question.

I didn’t see these things all the time. And that is the challenge facing the NHS.  But it shouldn’t be forgotten that I saw this and more every single day and it was done with little recognition or praise.  We should be thanking these people and fostering a positive culture in the NHS.This team inspired me to be the best that I can be and to never lose sight of why we are all really there: the patient.

Thank you to everyone at the Birmingham and Midland Eye Centre.

Tips for thriving on the 1st year of the NHS Grad Scheme

After 10 days of sun and amazing food in the Basque country I have had some time to reflect on my first year of the NHS graduate management training scheme. It has had its ups and downs, and I definitely needed this holiday, but I have learnt so much and enjoyed myself at the same time.   Here are my top tips for anyone starting the grad scheme:

1. The rest of your cohort will be there to support and help you, so get to know them.  This will be through uni days, action learning sets but also more informally. We have shared tips and reading lists for essays, supported each other through crises at work, and laughed about who has come up against the most red tape!  They are also an important resource for seeing how things are done in other hospitals- learning from each other should not stop in this era of increased competition.   Being the only trainee in an organisation can be isolating and one of the best things about the grad scheme is the links with the world outside your placement! Which brings me to the next point...

2. Make the most of the grad scheme opportunities. I have been to the NHS innovation expo where I heard from David Nicholson and Jeremy Hunt, as well as listening to a debate on open data in the NHS and how we can improve dementia care.  I also went to a master class on social policy with David Brooks and the charity Kids Company.  These were not directly related to my first placement but it was really good to get a wider view of health and social care as well as getting into the operational detail in my placement.  You can also do this through social media- I mainly use twitter but also through reading blogs. 

3.  Make the most of your orientation period- this is such a great opportunity to see a part of the NHS which we will probably never see again. Some really memorable days for me were spending a day in an ambulance, the hospital canteen, laundry service, and observing an operation.  Also remember that these opportunities don't go away after September, you can still ask to shadow people and get to know different departments although being busy might keep this to once a month instead of every day!

4. Everyone has a different first placements- different organisations and managers Have varying knowledge of the grad scheme, the level we should be working at and what kind of support is needed.  The key relationship is with your programme and placement managers, to ensure that any problems can be resolved early on and your competences are met.  If you have no luck there then talk to the local, and then national, leadership academy.  It is also helpful to compare what you are doing / what hours you are working etc with other people on the grad scheme in the same specialism. 

5. Buddy up with a junior doctor- they will give you an important insight into how doctors view the running of the hospital and they will learn more about management to prepare themselves for future clinical leadership roles.  Most junior doctors wont have met many managers before and the stereotypes go both ways (even the grad scheme was guilty of telling us how scary consultants are on our first day!). This will be easier for general managers to organise, so other trainees could start in their orientation.  You could ask a consultant or academic tutor if anyone knows a junior doctor interested in management, or alternatively you could try to get their emails from medical staffing.  

6. Relish the challenge- At the interview, when I asked why I applied to the grad scheme, I said that I didn't want a boring job, and that I wanted a challenge... That wish certainly came true! At times over the past year, when work has been piling up on my placement and essay deadlines are looming, I have had to remind myself that this is part of the learning, and the best thing about the grad scheme is being in a real job with real responsibility... So make the most of it and effect as much change as you possibly can! 

This year has flown by, so now it's on to my flexi placement at the Kings Fund and my second placement in strategy at Birmingham Children's Hopsital- any tips for these would be great! 

Tweet Tweet!

This morning, while brushing my teeth, I thought it would be a good idea to tweet everything I did that day. I recently read a blog by Mark Newbold on using twitter. A mixture of being busy, getting out of the habit and feeling a bit ground down at work has meant my tweeting has been limited! I thought that this would be a good way to get back into tweeting but it would also help me to see exactly what I am doing at work and also help to identify what is adding value or not. 

Apart from a few awkward moments explaining why I was spending so much time on my phone in meetings, I really enjoyed the day. I didn’t actually have much time to tweet, it really showed how much of my day I actually spend talking to people and walking around; not the best set up for typing on the go! But I think this really adds value and something that I really enjoy about my job; I love walking around and catching up with people, having impromptu discussions and solving operational issues on the spot. One of the biggest compliments I have had so far in this role was when the ward sister told me I wasn’t the type of manager who spends all their time in front of the computer! I also think it really helps to have discussions about service developments in the service area rather than stuck in a meeting room, something I have learnt from my current manager.

One of the great things about my role is how closely I work with clinicians, who mostly don’t have in depth knowledge of NHS systems, such as block contracts and new ccg arrangements. One thing I really noticed today was how many meetings go off on tangents when we start discussing wider issues in the NHS. Investing time in discussing this with clinical leaders is essential, however can be distracting from the task at hand! Even without this, the agendas aren’t that specific and the Chairs tend to encourage open discussion rather than creating actions. On the plus side there is lots of time for debate but mostly this leads to meetings which overrun and where no decisions are made, hindering our ability to work efficiently. A friend who is a teacher follows me on twitter commented that my day seemed full of meetings- so it is even more important that we make sure they are constructive.

A final point about using twitter: One doctor commented on how can I possibly have the time to be on twitter as well as my job, but I actually think that being a visible leader is something to prioritise. My twitter feed got responses from future NHS graduate trainees, current NHS managers, a leadership consultant from the Kings Fund and a junior doctor. Social media, when used correctly, encourages an open and transparent culture, with debate across all levels of staff, across professional divides, and most importantly with patients and carers.

In case you missed it, here are all the tweets I sent:

I haven't been tweeting as much recently, so spur of the moment decision to tweet about everything I do today on the @NHSGradScheme @SWBHnhs

First meeting at 9am, so a bit of time to catch up with colleagues and check my emails before that

First meeting with @CarlyJones_SWBH and the #bmec team to discuss the carrot walk and how we can fundriase for eye research

Love working with experts in their field, leads to lots of healthy debate #dayinthelifeNHSmanager

Next meeting now, on outpatient transformation #nhsgrad2012

Meeting is going off on a tangent... Discussing the NHS reforms and how we can effectively work with the local CCG

@LizSaunders4 now explaining block contracts to a consultant. Decided to tweet everything I do today!

Back onto outpatients... Will template changes help to reduce clinic delays?

Now discussing with the outpatient lead consultant and sister about nursing cover

Walk around of one of our clinical areas to see if it could be used more effectively and get some more clinic rooms

A&E service improvement discussion- was role is our elecronic patient record playing in increased delays?

Quick catch my with my manager about ongoing issues and now time for some lunch... Luckily one of the secretaries brought in some biriyani!

Really enjoying tweeting about my day so far, making me much more aware of how I spend my time

Bit of time over lunch to go through a patient pathway and see how virtual clinics can be incorporated

Outpatient nursing huddle- discuss any issues from the morning and anything predicted for this afternoon

Caught by a doctor asking me to reduce numbers in a clinic where we have capacity issues

Moving an outpatient clinic to a new area in 2 weeks- making sure everything is available, still missing a computer on wheels

Discussion about coding - something that I want to learn more about but I am struggling understanding how it all works

Starting the divisional team meeting- divisional director, divisional general manager and finance manager

Medical workforce update and job plan discussion at the divisional management team meeting

Update from the trust's business development team, how can we use all the information we have to develop strategy?

Discussing which services should be growing and which should be shrinking, and how can we develop local strategies

Looking at data of inpatient activity from local ccgs by hospital... How can we use this data to inform our strategy?

Quick detour to talk about opportunities for my 2nd placement

Finance update in the divisional management team meeting- there are a lot of long term vacancies

Looking at the data for premium rate working and discuss if it can be reduced without affecting the service

Finished last meeting, quick catch up with my manager and now checking my emails

Finish the day with a chat with one of our consultants who us off to Afghanistan on Sunday for 2 months

The Blackpool Way- Julian Hartley

I have blogged a lot about meeting current nhs leaders and I hope it isn't getting too boring but it really is one of the best things about the grad scheme! It is so easy to get bogged down in the day to day firefighting in my operational role, and hearing some of the great changes that people have made is really inspiring and also gives me hope for the future.

Julian Hartley, the new chief executive of NHS quality improvement spoke to us about three key ideas developed as part of 'the Blackpool way' which I will try to follow in my current and future leadership positions.

1. Great communication. This includes visible senior leadership and setting the tone of openness. In my current placement I work closely with the divisional general manager, who is hardly ever at her desk, as she spends a lot of her time out in the clinical areas talking to staff and patients! Whilst this is excellent, there isn't much written communication on a local level that means that the key messages are not getting out in a consistent way. Julian also discussed a rumour board- where anyone could submit a rumour anonymously and the answers from the trust board were published on the intranet.

2. Recognition. Thanking people formally and informally from the executive team down creates a positive environment. This also ties in with a recent blog post I read about the 'imposter' syndrome. The majority of nhs leaders feel at times that they are not up to the job, and that they will get 'found out' at any minute. Recognition when it is due is a key way to tackle this and support colleagues in their roles. However it is clearly not about tolerating poor practice, or appreciating mediocre behaviour, but making sure thanks are loud and clear when they are due.

3. Enlightened management style. Julian talked about some ideas which he managed to embed into daily practice. As part of 'the Blackpool way' each manager had an evaluation done by their subordinates on to what extent do they live by the values of the organisation. These scores were then built into their appraisals. Another story he told was about before he became the chief executive of Blackpool, he wrote a letter to each senior manager to ask them what they thought the three top priorities were for the organisation. He learnt a lot even before he got there about the staff, their opinion on future strategy and improvements needed in the organisation.

Whilst a lot of the conversation revolved around key changes that had been implemented, Julian also cautioned us about making changes for the sake of it. When new management comes in, making big changes becomes part of making a mark and symbolising a new leader, but this isn't always necessary. This was a good end to a day discussing service improvement, as there is a tendency for changes to be made quickly with no real insight into the root cause of the problem, and changes are not given enough time to embed before a new management 'craze' is tried instead.

Meeting Inspiring Leaders...

One of the great things about the grad scheme is the opportunity to meet NHS leaders who have been generous in giving their time meeting and mentoring management trainees. I have been working with a junior doctor who is interested in management who doesn't have these opportunities so this week we went to meet Mark New bold, the Chief Executive of Heart of England FT. He spoke to us about his career in medicine and how and why he got into management.  We also discussed 4 hour waits, leadership styles and the increase in junior doctors getting involved in management. But what was really heartening for me about meeting Mark was the way he deals with some of the really difficult decisions in NHS management.   

I have been reading Mark’s blogs and diary for a while and I really like the way he explains some of the key issues in healthcare at the moment and how he is dealing with them.  He explained to us that he uses the blog to externalise some of the 'wicked' problems he is facing, such as the 4 hour target. When the whole of the  country  is  struggling with pressure in A&E, how can he ensure that an individual acute trust meets the target? Although at a completely different level, I can identify with facing challenging situations at work.  Most of the time the crisis nature of acute trusts means that there isn't time to put together an informed action plan, and often there isn't a lot of data available to inform key decisions anyway. Most of the issues we are facing don't have a known answer, and certainly no easy answer. Being quite new to the NHS means that I also don't have the past experiences that can be used to inform decision making. However, spending time with experienced NHS leaders means that I can benefit from their expertise.  

I also heard a talk from Emma Donaldson, a doctor and quality improvement lead from Salford Royal Hospitals.  She described how they have managed to improve the quality of care they deliver, through engaging with members of staff at all levels.  The executive team each spend half a day a week delivering front line care, and the chief exec uses this time to put on his health care assistant uniform and clean the top of the curtain rails on the wards! Emma also talked about their different model for clinical leaders- a topic that I find really interesting.  All their clinical leaders have gone through a leadership assessment centre and they have two contracts, one for their clinical work and one for their managerial work, which includes targets and accountability.   A clear link was made to the clinical leaders between mandatory training compliance and saving money- the reduction in insurance would be passed on to the divisions if their mandatory training was up to date! If not, extra savings would have to be made, and this responsibility lies directly with the clinical leads.  

Meeting both of these inspiring NHS leaders has shown me examples in the NHS where the culture is changing through determined leadership.  It is good to see examples of situations where the endless paperwork, pace-setter culture and slow moving nature of the NHS has not been a barrier to enabling change and gives us all something to work towards!

The Generation Game

One of the biggest challenges facing the NHS is that the pre-war “grateful generation” is being replaced by a new generation that are more demanding and less satisfied with the NHS.  This graph shows that the pre-war generation is consistently more satisfied with the NHS and that as the “baby boom” generation is getting older, they remain less satified with the NHS, showing that it is not getting older which is the primary explanation, but a generational difference.  This could be because the pre-war generation witnessed the birth of the NHS, are proud of it and remember a time when it did not exist.

This difference between different generations was shown to me after a heavy fall of snow in January.  A patient, in her 80s, knew about a forecast of heavy snow but she didn’t want to waste the doctor’s time by not coming and therefore made her way to the hospital in the snow.  A few hours later, the patient was stuck in the hospital with no way to get home due to the heavy snowfall.  I ended up speaking to the patients daughter, who wanted to leave her mother at the hospital for a few hours.  I spoke to her daughter again a few hours later, and she asked me to find her (well) mother a bed for the night in the hospital so she could go home tomorrow when the snow had melted.

So within a single generation, there was a mother who would not dream of wasting the NHS resources by cancelling an appointment with the doctor, and a daughter who expected the NHS to find her mother a bed, nightclothes and a hot meal.This difference shows the change in mentality in a single generation and is one of the big challenges facing the NHS.  However, this can be used positively, by using patient’s opinion to improve and evaluate services, and to stop seeing patients as passive recipients of care but instead as active participants in their own care.

Public Trust Board Meetings

Last week I went to the trust’s public board meeting, partly out of interest and partly as I am writing an essay for my masters on governance. What immediately struck me was that there were no members of the public there. A quick survey of other trainees told me that not many members of the public attended other hospital public board meetings, apart from in one trust where the public came to protest about a controversial decision.

I suspect members of the public would not be that interested in listening to executives discuss various issues such as the acquisition of a new building, the financial status of the trust and the progress of the foundation trust application for nearly four hours, using terminology that most people wouldn't understand. This information should be in the public domain, and the public should be invited to attend, however it is understandable that this may not be the most engaging arena to involve our local communities.

This leads to the next question; how can we involve our patients, staff and local community groups in the running of the hospital, keep them informed and engaged about developments and give them a voice in decisions to be made? The trust has an active website and twitter account, but this is only reaching a certain population group. What about having health and well-being events, where we could promote key health messages, our services and perhaps have some local charities and community groups there as well? Or a farmers market which would help local businesses as well as promoting healthy eating? These occasions could also be used to give key messages from the trust board in an interactive and easy to understand format to staff and public, and give everyone a say in key decisions. Can you think of any other ideas that you would like to see, or great examples you have seen from other hospitals?


First Published 12/03/2013 on the SWBH Website

Communication

This week at BMEC has been all about communication. In the current climate and with increased competition in the NHS promoting our services is becoming essential. This is quite a new concept for the NHS and something that has been done to varying success in other trusts. Every member of the team can participate, for example through social media, posters and leaflets, partly to promote our services to the local area and beyond, but also so that in a large trust other staff members from other departments will know what is happening and so that we can show pride in our achievements.

Within the Birmingham Midland Eye Centre, we have discussed using twitter to promote our services and give key eye health messages, getting some patient stories together and encouraging members of staff to write “a day in the life of” blogs… so watch this space! We will be starting with World Glaucoma Week on the 10th March, which coincides with one of our surgeons performing a new, less invasive glaucoma surgery technique.

Meeting the communication team also included the fundraising team, who have persuaded me to join them in a 10k run in April. And on the note of fundraising; Surgery B’s divisional general manager Jaki Mills, who has been teaching me all about leadership and service improvement during my placement, has also shown her daredevil side by jumping out of a plane to raise money for our brand new ophthalmology research facility. To sponsor Jaki click here.

I’ve also been working on a video to show at our governance afternoon in a few weeks. As we will be shutting down all of our activity (apart from emergencies) for the whole ophthalmology team to get together for an afternoon it is important that we make the most of this opportunity. As well as talks on recent audits in the department, a video will be shown on the importance of robustly checking all patient details and carrying out the WHO surgical check list.

One of the best things about the NHS management scheme so far has been that no two days are the same, a thought I definitely had when I was filming the theatre team this morning!



First Published 15/01/13 on the SWBH website

Coaching and Mentoring

I started this week with a meeting with my mentor, David Melbourne the acting chief executive at Birmingham Children’s Hospital. On the NHS graduate scheme we are encouraged to meet with the chief executive of our own trust, as well as finding a mentor externally. Before John Adler left SWBH, I had some great meetings with him hearing about the start of his career on the graduate programme, and the challenges he faces as a chief executive, as well as getting advice on my first placement and career suggestions for the future. I know it is an opportunity that not many people get and it is definitely one of the best things about the scheme.

According to the Leadership Academy, the purpose of mentoring is to provide guidance and support in the overall direction of a trainee’s career, and to help a trainee to improve their performance and develop their leadership skills… not a small task then!

This week I asked David to go through ‘coaching’ with me. I would like to be able to give feedback to colleagues in a conversation where they feel supported and gain an insight into how they would like to improve their performance in the future.

It is very tempting to either ignore the situation, or just say “this is what you did wrong, don’t do it next time”. Actually, this is how the GROW method of coaching came about. A tennis instructor realised that he could tell the tennis players what they were doing incorrectly, but this did not bring about lasting change, as people only follow instructions for so long (or not at all!). The tennis coach decided to start asking the players questions so the players could discover for themselves what was going wrong.

In my mentoring sessions, we used examples of conversations at work and used role play to go through some of the open questions I could use in the future. It was much harder than I expected to keep asking questions rather than jumping in with my own opinion- definitely something I need to work on! You can read more about the GROW method of coaching here.

Another thing I enjoy about mentoring is spending time in a different hospital. Birmingham Children’s Hospital has a very strong brand which is essential for the huge amount of fundraising the BCH charity does. The hospital values are also clearly displayed everywhere in the hospital in an eye-catching way. We can learn so much from visiting other hospitals and working together and I hope that the increasing amount of competition in the NHS doesn’t discourage this in the future


First Published 21/01/2013 on the SWBH website

What is my team role?

I have started 2013 at work by doing the ‘Belbin Test’ to find out my team role. I answered a questionnaire about statements that I would use to describe myself. For each category, for example ‘when contributing to group projects in general’ I choose two statements that I thought most applied to me. In this category I choose; ‘I try to make my mark in group meetings’ and ‘I get on well with others and work hard for the team’.

When adding up my final scores, I got a final team role which applies to me, according to my own perception of my skills. I received equal points for Shaper and Team Worker, both quite different categories.

A shaper is highly strung, dynamic and outgoing which is great for motivating others and facing challenges, but can also be impatient and headstrong. On the other hand, team workers are mild and sensitive, encourage team working and although they are very diplomatic, they sometimes be indecisive in a crisis. I wasn't that surprised that I came out as these categories, but I was surprised about how different they are! I think that I become a different style of team member depending on who else is there- for example if there is tension within a group, I often find myself trying to be the diplomat, but in a different situation I might be very headstrong and not back down! To some extent this is the same for everyone, we mould our personalities according to the needs of the situation.

Being a reflective leader is something that is encouraged by the Leadership Academy, who run the my training programme, and at the end of every day at work I try and think about what went well and what I could have done better. I am also looking forward to doing a 360 degree feedback evaluation once I have been in my role a bit longer.

I have recently come face to face with some of the realities of hospital management – just before Christmas I struggled to understand why the targets encourage you to not perform surgery on patients who have already breached, and also how much pressure targets put on the division. This week I have tried to move two theatre lists from Sandwell over to City to help with the need for extra theatre capacity in Sandwell on a temporary basis due to norovirus disruptions. It has been a lesson on how many things go into getting a theatre list running – it took us a lot of time and negotiation to find a time when the doctor, an anaesthetist, the theatre staff and an operating theatre were all available.

What I have been enjoying the most is working with lots of different people, who all have different team roles. We discovered this in a team building challenge of “who can build the tallest structure out of spaghetti and marshmallows” This was great fun, a good opportunity to get to know each other better and to reflect on the qualities that we would like to contribute to our outpatient team.


First Published 04/01/2013 on the SWBH website

Achieving Goals

For inspiration for my blog post this week, I have taken inspiration from another blog which uses the method “thinking differently” in order to think creatively about situations. It can be tempting (and let’s face it, easier) to talk about problems by recycling the same old solutions, but this method aims to start people thinking creatively and outside the box.

I opened a book on a random page and shut my eyes (honestly!) and I got the word “goal”. I then started to think about my placement in terms of this random word.

The first thing I thought of was the goal of everyone working in the hospital; for patient care. The team should be working together to improve patient care, from the receptionists welcoming the patients to the clinical staff going the extra mile. This week I collected some positive feedback from patients and put it up on a board in outpatients to thank the staff for reaching our goal of making sure patients are happy and comfortable in the department.

On one of my first weeks here I was in the office when a doctor came up from A&E to tell the divisional manager there was a problem. A patient had severely injured his own eye in self-harm whilst on the way to a psychiatric unit. The team around the patients care was extensive- the police, social worker, doctors, nurses, managers, theatre staff, psychiatrist, RAID nurses and the on call surgeon were all working for the goal of getting the patient to theatre and saving his eyesight. There were multiple complications but the team was motivated and went above and beyond to ensure that the patient had his emergency surgery and that goal was achieved.

However, this was an achievable goal in the near future, which would make the difference between saving the patients sight or losing it. The goal of “patient care” can get lost as it includes so many different things, it is difficult to define, and it does not have an end point, and gets lost in the reality of the day-to-day routine. Getting the A&E patient into emergency theatre was a short term goal with a clear outcome and was therefore easier to define compared to the woolly “patient care”. For example, if a patient chooses to stop eating which may result in harm, should the nurse force the patient to eat? What if a family wants to deny telling the patient the truth about a medical condition? The goal now seems a bit more confusing….


First Published on 28/11/12 on the SWBH Website

Leading Improvement Through People

I feel like I’ve travelled loads this week, as I went to University Hospital Coventry on Monday to meet some of my colleagues from the graduate programme for our first action learning set;

“Action Learning is a process underpinned by a belief in individual potential: a way of learning from our actions and from what happens to us, and around us, by taking the time to question, understand and reflect…” This process enables us to gain insight, develop as an individual and make informed choices and decisions about how to act in the future (Weinstein 1999).

It was great to get to know some of the other management trainees and discuss our experiences so far. We chatted about how we got to this point in our careers and what our major influences have been. For me, my mum played a big part in showing me passion and commitment in her job as a paediatrician. I’ve also had some really great managers who have shown me the kind of leader that I would like to be.

On Tuesday I went to Manchester for a day of lectures for my masters in service improvement for the module “leading improvement through people”. We talked about what leadership is and the NHS leadership framework. The leadership framework can be seen as so open ended it becomes generic, and also full of clichés such as my current module- how else is improvement going to be achieved if not through people? But overall, I think it is a useful framework for all the components of good leadership.

I would recommend reading some of the Francis report part 2, which is a collection of all the patient stories from the Mid Staffordshire enquiry. With all of the headlines and policy changes, it is still shocking to read the patient stories. We discussed how the leadership quality “acting with integrity” can be lost in an organisation and how this can be prevented.

I have been back in the office for the last part of the week, and I went to an outpatient "Listening into Action" where we discussed improvements that could be made in the BTC. I was pleased to hear that huddles have been recommended- we are enjoying them here in BMEC! I visited Rowley Regis, and I also went to a teaching session for junior doctors about finance. In outpatients we will be reviewing all the clinic templates in order to reduce waiting times and focussing on making sure the 18 weeks outcomes are filled in by the doctors… which will be a challenge!!


First Published on 14/11/12 on the SWBH website

Building Relationships

Now I’ve had a few weeks to settle in to my new role here at Sandwell and West Birmingham Hospitals, I’ve got to know Surgery B a bit better and got to know some of the staff. Everyone has been really welcoming and very supportive, and it’s been great working with all different members of the Ophthalmology team, the nursing staff, medical records team, managers and doctors across the department.

I’ve been asked a few times by different people about why I decided to get into NHS management. It can have the reputation of getting in the way of patient care, of “pen pushers” who only care about money, and it is a job that is sometimes viewed negatively by the press and the public. So old and new colleagues have asked me…why did I choose to do a management programme in the NHS when I could have joined a private company?

During my time at university, I volunteered for the afro Caribbean leukaemia trust (ACLT), a charity which aims to increase the number of Black and Minority Ethnic (BME) donors on the bone marrow register. Bone marrow donation is race specific, and less than 3% of potential donors on the current register are from ethnic minorities, so when someone from one of these communities needs a bone marrow donor their chances of finding one are much less than white patients looking for a match. When I left uni, I taught English in a Somali community centre to a group of women and two classes of teenagers (the teenagers were definitely a challenge!). These experiences showed me that I am motivated by working for something that I believe in. I applied for the NHS graduate management programme despite the fact that it will be a tough challenge, especially in the current climate of the NHS. I believe that good management, working alongside clinical colleagues, does have the potential to improve patient care. I hope to counter some of those stereotypes about NHS managers and show that the reason I chose this graduate programme is that I am passionate about patient care and I believe in the core values of the NHS.

Over the last two weeks I have been getting to know the outpatient team by joining them for their huddles twice a day. These 5 minute team meetings are a great way to raise any problems from the day before and highlight anything out of the ordinary for the day ahead so the whole team is up to speed. Getting to know the outpatient team has been a highlight, while the lower points have probably been feeling very confused at finance meetings trying to interpret all the data and understand all the abbreviations! I have also teamed up with a doctor who is interested in management, and we will be following a programme which aims to break down the professional divide between clinicians and managers. This is alongside preparations for my next two days at uni, where I will be getting to grips with “Action Learning” and “Leading improvement through people”…so very busy but I will keep you updated!


First Published 01/11/12 here

New Job...

I have recently started at Sandwell and West Birmingham Hospitals as a management trainee, working in the Birmingham and Midlands Eye Centre. I am on a graduate training programme for two years, the first of which will be as a general manager in Ophthalmology for 12 months. I started in the beginning of September and I have had a very warm welcome so far!

My first month was an orientation of the whole of the NHS, which I think is an impossible task even with unlimited time! I did fit in as much as possible, and I got a great overview. It was especially good to see parts of the hospital that most staff don’t get a chance to see… I spent time with the ward service officers, I served lunch in the Sandwell canteen, I shadowed clinical staff in critical care, A&E and I went out with Dudley Ambulance service, as well as finding out more about finance, HR, bed management, trust sustainability and the pathology services. It has been a very busy month and I have learnt loads.

Alongside my job in BMEC, I will be doing a masters in healthcare management. I have started my first assignment on patient experience. I really enjoyed meeting some patients and discussing their thoughts about the day surgery unit; it was great to hear all their positive comments and some great ideas on how to improve things, mainly by increasing communication around waiting times so that is something I will be looking into. The aim of the assignment is to see a service through a patients’ eyes, and it was also great to start a new job with the patient at the centre of the service- something I hope to continue with throughout my time here.

So, I will be blogging about a day in the life of an NHS manager, but so far it seems no day is ever the same! This morning I went to the equality and diversity conference and learnt about the charity Kissing it Better and heard some great comedy from deaf comedian Steve Day. I have also been getting to know the outpatient team and going to their team huddles- a great way to start the day and air any problems from the day before.

Now I’m ready to get started in my role and also get involved in other parts of the trust… I have been tweeting about my orientation (@LydiaBenedetta) and Carly might even persuade me to do some fundraising!



First published on 17/10/12 on the SWBH website