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.