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