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Articles from Training Bulletin

Here you can find all the articles that have been featured in previous issues of the Training Bulletin.

Psychological Factors in Appraisals

The hardwired block to objectivity

Appraisals are typically approached with a mixture of scepticism and distaste, both by those being appraised and the appraiser themselves. However, with so much weight placed on the appraisal process as the primary method of assessing doctors for revalidation, it is vital that appraisal is both acceptable and effective at delivering its purpose. NHS organisations often seek to improve the appraisal process by providing training for appraisers, however, that training seldom includes one of the most significant confounders to appraisal effectiveness – psychological difference. This paper highlights some of the most important aspects of difference and how they impact the appraisal process.



From Conflict to Collaboration

Simple solutions with resounding impact

Conflict comes in many forms but two common delineations are warranted conflict, where we share a simple difference in opinion, versus unwarranted conflict, where psychological diversity causes a breakdown between individuals or groups. In the healthcare environment it is more complex%3B with factors often interrelating to create long term institutionalised conflict, often termed the clinical-managerial divide. In an increasingly hostile environment this is a significant source of risk, where energy expended in internal conflict could be better utilised improving competitiveness.



Why Lean Fails

Ensuring Lean Success

With so many organisations failing to successfully improve performance through Lean, often despite massive financial and time investments this short article explores some of the key factors that will make the difference between success and failure.



Cost Improvement

Achieving engagement by evolving culture

As the NHS enters a period of considerable financial famine, the cost improvement programme or CIP is set to become part of everyday practice for most services. However, service leaders are more likely to find that their teams are reluctant compliers than enthusiastic engagers and this persisting culture ensures that CIP will remain difficult, painful and potentially inadequate as services strive for financial stability against rising demands and falling revenue.



Promoting Clinical Academic Careers To Young Doctors

Academic medicine and clinical practice

The celebration of 60 years of the NHS highlighted that whilst the principles underpinning the provision of healthcare for all remain, day-to-day practice has been revolutionised by recent scientific discoveries. For example, the availability of effective treatments for cardiovascular disease (beta blockers%3B ACE inhibitors%3B statins), advances in imaging technology (ultrasound%3B MRI scans) and developments in assisted conception and regenerative medicine have transformed healthcare in the late 20th and 21st centuries. A career in clinical academic medicine could provide you with the opportunity to have an impact on the lives of many through education and research.



The Evolving NHS Landscape

The dangers of not understanding the system you are in

As the evolution of our health system takes hold, many services are discovering the hard way that their level of understanding falls short of that necessary to ensure safe passage through increasingly troubled waters. Playing any game when you don’t understand the rules is tough but in healthcare it comes with increasing risk in many forms.



Leadership Challenges

The critical nature of nursing leadership in a competitive service

The successful service of modern times relies on a committed workforce aligned, single-mindedly, behind a good strategic plan. Perhaps more important than the plan itself is the ability of the team to pull together towards its attainment. Motivating people towards a distinct goal or vision is very much the realm of transformational leadership and yet in healthcare we have tended to stick very much with the more hierarchical, autocratic styles. Furthermore, despite the vital nature of aligned consistent activity, we have also grown different vertical streams of hierarchy (medical, nursing, allied, management etc), with each having comparatively little influence over the others. Nursing has remained more ‘standalone’ than any other stream. Given that nurses make up 30% of the workforce, it is vital that nursing adopts the same drive for effective leadership that is currently expected of medical staff, despite (especially in) the current economic climate.



E-learning

Reducing cost in the delivery of statutory learning

The UK health service (we refrain from calling it the NHS, as it decomposes into smaller component parts) employs approximately 1.3 million professionals, of which around half are clinically qualified in some form or other. Regardless of individual focus, there are growing requirements for mandatory or statutory training in vast numbers of staff, with increasing pressure on training budgets. As statutory or mandatory training grows, it has the potential to block provision of specialised training designed specifically to enhance individual performance. In truth, regardless of the idealist position that we should provide all of the mandatory, statutory and individualised training necessary to enable a person to be both compliant and effective, cold hard financial reality dictates that we must make choices. As the statutory and mandatory burden grows, so the specialist training must dwindle in order to balance both books and time.



Lean

More than just a bag of tools

In a bid to transform services and improve value for money many healthcare organisations have turned to Lean as the basis of their improvement efforts. Lean is not a new concept and its origins can be traced back to the 15th Century when the Venetian Navy introduced a ‘flow line’ for the production of war ships. Most people though would trace its history from its implementation within Toyota where is acquired the name of the ‘Toyota Production System’ and this became ‘Lean’ in the book ‘Lean Thinking’ that was published in 1996.



Corporate Conflict

Understanding disagreement versus conflict

he combination of increased expectations, reducing resources, shorter waiting times and explicit service targets, conflict is not surprisingly on the increase. The team environment in healthcare is much akin to a witch’s cauldron, containing a culturally, intellectually and socially diverse collection of ingredients stirred together. The more you turn up the heat, the greater the reactions that bubble away inside and the more toil and trouble you get on the outside (it’s close to Halloween, what did you expect!). This article though, seeks to deal with a growing issue that need not be a growing issue at all – the inadvertent classification of disagreement as conflict.



Appraisals

Core Components of Effective Appraisals

With revalidation and re-certification looming, appraisal has taken on a whole new level of importance. However, we are also entering a period of danger where appraisal switches from its core purpose to one of simple compliance with recertification requirements i.e. appraisal is structured and undertaken purely as part of the wider process of maintaining licensing to practise. The ultimate risk of tick-box appraisal is that we lose a vital component of an effective performance management system. Conversely though, perhaps we can use this as an opportunity to establish effective appraisal systems that drive enhanced performance rather than just deal with clinical fitness to practise.



Leadership Lessons

Putting the right leaders in strategic clinical leadership roles

When it’s time to volunteer for the role of Clinical Director, people often say “everyone took a step back but I was the slowest”. With comparatively few exceptions, some surgical specialities being notable, services the length and breadth of the country have a reluctant leader at the helm. When service ‘administration’ was the order of the day, this held comparatively little disadvantage but as we move towards strategic service leadership or indeed Service Line Management, this all too common finding potentially denies services the natural drive that is necessary to excel in a harsh, competitive economic climate. And that’s not the only problem...



Team Effectiveness

Developing team effectiveness in an era of financial famine

Commercial organisations expend considerable sums on team development programmes and yet traditionally NHS organisations spend very little, if anything at all. So why such divergent approaches? We believe the answer lies in the public purse, is potentially disastrous long term and that a solution must be found within the context of ever deepening financial famine.



Safeguarding Children 2009

Review: Getting it right across the NHS - 21st October 2009, London

The conference started early with a full day ahead of us, packed full of insight, expertise and discussion. After a surprisingly warm October introduction to the day our meeting began with an exhilarating start from Sue Eardley, Head of Safeguarding at the Care Quality Commission and Professor Terence Stephenson, President of the Royal College of Paediatrics & Child Health, covering lessons and imperatives for the NHS and the challenges to healthcare professionals on the road to improving safeguarding. These presentations really kick started the day and were a fine example of the quality and content that would be covered throughout the day by our credible speaker cohort.



The Foundation Trust Trap

The Carrot, the catch and the crucial imperative

Perhaps trap is too strong a word but it does imply something you fall into because you didn’t notice it and at that level the word carries the meaning suitably well. Furthermore, the trap itself, whether by design or inadvertently, is particularly well crafted. So, what are we speaking of? You could call it a funding trap but we’d prefer to describe it as the trap of self-determination and it gives rise to some vital imperatives if organisations wish to avoid being impaled on the spikes at the bottom.



EWTD for Junior Doctors

New technology rides to the rescue

From 1st August 2009 almost all junior doctors in the NHS are supposed to be working an average week of less than 48 hours, with perhaps 10% allowed to work up to a 52-hour week because of a transient derogation from the regulations. It will have been a difficult month for all concerned – the EWTD, a change-over of staff, summer holidays, unfilled posts, few locums or international medical graduates available, and swine influenza – though swine flu is the only problem that failed to turn-up in August.



Medical students to have more ‘hands on’ experience

Professor Jim McKillop, Chair of GMC Undergraduate Board

Today’s undergraduates – tomorrow’s doctors – will see huge changes in medical practice. Becoming a doctor today is about so much more than understanding how the body works and developing technical skills . The demands of a doctor mean they must be excellent communicators, leaders and negotiators. They need to understand a condition in relation to a patient’s environment, beliefs and outlook and communicate with them in a way that the patient understands.



PCT Provider Arms

Growing the right kind of legs to survive and thrive

As more and more PCT Provider Arms are moved to arms length, we want to explore the heart and soul of the legs that are required in order that they may stand on their own two feet – phew, that’s a lot of body parts for a first paragraph!



E-learning – The opportunities, the limitations

and the danger of letting the geeks control it!

With the ubiquitous nature of personal computers and the internet, reducing costs whilst expanding development possibilities through e-learning appears to be an attractive proposition. Today’s modern healthcare, office and home environment means that almost everyone has access to a PC with broadband internet access and this opens a world of opportunities for training and development of staff.



Team Effectiveness

The role of psychological tools

Encouraging effective team working sometimes seems a bit like riding a roller coaster. Just as you think you have got it nailed it races downhill again. And you’ve probably noticed, it positively hurtles downhill but chugs slowly back up hill. This is in part due to the multifactorial nature of team performance with a myriad of factors involved in the final result. We’d like to explore one aspect of team development – that of the role and use of psychological tools.



Corporate Conflict

Reducing the clinical-managerial divide

Corporate conflict tends to exist whenever individual or group interests appear to diverge within an organisation or where the organisational direction seems to be departing from the values or goals that the workforce believes are underpinning its true purpose. Within the NHS intraorganisational conflict between managers and clinicians is often very high, with each party appearing to have an agenda which is incompatible with the others. Whilst in the past organisations might have continued to survive in spite of this internal conflict, survival and growth in the new world will become increasingly difficult in those organisations where a clinical-managerial divide remains.



Leadership Lessons

What can be learned from the DH Staff Survey?

Annually, over quarter of a million staff (289,000 in 2008) are invited to participate in the NHS staff Survey, resulting in some 160,000 respondents and eliciting a wealth of data on the experiences of staff working across all manner of NHS organisations. Used intelligently, the insight contained within could hold the key to resolving some of our greatest human-related challenges, as well as providing a stark wake-up call in some topic areas. We’d like to focus on what leadership lessons can be drawn from the survey results.



Hospital-at-Night

What’s its true place in a competitive service?

Hospital-at-night predates much of the move towards a competitive healthcare market economy but is an essential component of the overall care a person receives. Whereas clinical excellence will always be the true mark of a successful service, there is growing recognition that there is more to a successful service that the outcome alone. Is it time to re-visit hospitalat- night to re-evaluate its true purpose and how it contributes to overall service success in our increasingly unforgiving environment.



Appraisals

What should it really look like?

Reducing the psychological impact on participants Appraisals are now firmly a fundamental part of NHS life. Despite their vital contribution to effective performance at both an individual and an organisational level, they are often seen as having no valuable purpose, often no more than a quick chat, possibly even a tick box exercise and all too commonly as a negative, control-orientated process. What is clear, is that the value of an appraisal is fundamentally linked to the perceptions arising about it or within it and the impact it has the on the individuals concerned. Get it right and it can deliver enhanced performance and sustained individual growth. Get it wrong and it can destroy morale, cause frustration and undermine the very performance it is designed to enhance.



Patient-centred Healthcare

What should it really look like?

As a child in the late 1940’s I spent several months in bed with rheumatic fever and pericarditis. It was a serious illness for which there was then no effective treatment. I have never forgotten my mother’s devoted nursing care or the kindly paediatrician who always made me feel as though I was the only patient who really mattered to him. For them, care was all because there was nothing else they could do. Now fastforward to 2009, and contrast their attitude to care with the outlook of a nursing team leader – also a conscientious woman – who shocked me recently when she said that she ‘didn’t need to care to do her job properly’. She sees herself as a technician, but is she really patient-centred?



Safeguarding Children

Extending the learning across the NHS

The extensive media coverage of events around the tragic death of “Baby Peter” have largely focussed on apparent inadequacies in social services, care, focussing far less on the many missed opportunities within healthcare which resulted in Peter’s death at the hands of members of his household in August 2007. This short article, linked to a presentation at the Safeguarding 2009 conference explains how a regulatory focus is supporting transformation of the priority of safeguarding in the NHS.



The Link Between Morale and Performance

A lesson only just being learned by the health service

When there is generally strong acceptance that happy, motivated employees produce the greatest levels of performance, why do healthcare organisations place so little emphasis in this area? Some organisations may feel that this is an over-generalisation but even those who consider themselves mindful of employee motivation and morale tend to approach the subject very differently from their commercial counterparts. This article seeks to raise awareness around the importance of a motivated workforce, as well as highlight some of the dilemmas existing in the Public Sector.



Delivering Excellence in Customer Experience

Is this powerful PR or a pointless luxury in times of hardship?

Patient involvement, patient journey, patient experience, patient choice, patient this and patient that. It is not uncommon for the healthcare professional to question the role of the patient in healthcare beyond simply being a patient. Many remember the days when patients turned up, sat patiently, were treated and went politely on their way. So why the enormous cultural shift to ‘customer is king’ mentality? We’d like to explore the growing importance of delivering a customer-centric service before services lose both patients and patience.



New NHS Complaints Procedure

Subtle evolution or radical reform?

The new shared complaints procedure for both health and social care%3B ‘Listen, Respond, Improve’ came into force on 1st April 2009. The premise for the change was to make the procedures more personal and flexible whilst ensuring that all those involved in an actual complaint learned appropriate lessons that could be used to improve service provision. We examine the new procedure and invite the rhetorical question – does the revised version represent a subtle evolution or a radical reform.



Challenges facing the Hospital-at-Night Team

Organisation, Isolation and Engagement

Hospital-at-night was heralded as an innovative solution to ever reducing junior doctor hours and the knock on effect of this on training. Implementation has been much more challenging that originally predicted, with real gains in service delivery on fewer staff but questionable benefit from a training perspective. On the grand reality sees many working at terminal velocity with scant opportunity to reflect on their learning during the frenetic night time environment. We examine just a few of the challenges facing the team at night.



Setting goals & delegating using smarter SMART

Improving accountability and the likelihood of completion

The SMART framework or mnemonic for goal setting has been around for a very long time and there are a great many versions of what the letters stand for. Without question, setting goals or delegating in a structured manner helps goal achievement but we think that the framework needs some optimisation if you are going to derive the full value. We propose a version amended from the commonest representation that may yield greater accountability in those being asked to achieve SMART goals or undertake work delegated to them.



Optimising Approaches to Case Management

Harnessing greater benefits across a wider case mix

Case management has been widely introduced as a model for the management of patients with complex needs and at high risk of unplanned admissions as a result of long-term conditions. Defined by the Department of Health as "A service, led by a community matron or case manager that provides proactive, coordinated care to people who have an intricate mix of health and social care needs. It provides an intense level of care, preventing people from unnecessary admission to hospital and providing more care in the person’s home or community setting. It supports carers by relieving them of having to coordinate services and navigate a range of health and social care systems." It is hoped that case management, by targeting the 5% of patients who account for 42% of all admissions in the UK, will significantly reduce the secondary care burden.



The Art of True Learning - Approaching the Game Plan

Augmenting the acquisition of a CCT with career-enhancing depth

Few would disagree that working towards specialist qualification has changed radically in recent years and that doctors in training and consultants alike regularly express concern at the depth of experience being grown in today’s upcoming doctors. Although systemic factors adversely affecting learning, such as reducing junior doctor hours to comply with working time directives, are relatively straight forward to identify they are equally difficult to address as an individual. This article focuses on organising principles that re-assert the art of true learning.



Supporting Juniors, The good, the bad & the not so ugly

Training, mentoring & consultant support in the new world

Twenty one years after qualifying from Medical School and after 12 years as a consultant neonatologist, I decided to retrain as a GP. What did I learn about induction, mentoring, training and support from the junior doctor perspective? What lessons can be learnt by consultants of today? How can some services do it so well and some so badly? I was privileged to do three 4 month posts, General Practice, Medicine and A&E before I decided general practice was not for me. What can these specialities learn from each other? What can we all learn?



Constructing ideal learning

Balancing competency versus productivity focused development

Ongoing learning and development is an essential component of a healthy organisation and few would disagree. However, pick any component of a learning programme and you’ll find considerable polarisation around whether it is effective in improving organisational effectiveness. Controversially, we are all prepared to sign up to the principle that training is vital and yet demonstrating a functional benefit of training delivered remains the Holy Grail of training and education providers. The provocative question is “if training is so vital, then why can’t we measure its effect?” This article examines why it is so difficult both from a measurement perspective and from a standpoint that much development is at best incomplete when it comes to driving organisational effectiveness.



Work-life balance

Achieving the impossible?

As the NHS apparently moves towards a more workforce friendly approach to organising its human resource, we examine whether more controlled hours, flexible working arrangements and better pay add up to that elusive aspiration known as work-life balance. What else plays a part and how can you best adapt your working practices to suit the modern era of healthcare?





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