This year’s FMLM national conference in Manchester didn’t simply serve to educate and enthuse the healthcare professional masses on the merits of effective leadership in the NHS, it also provided real answers to the hospitals around the country in ‘emergency measures’ – an annual occurrence (like Christmas and at the same time as Christmas) when there is simply nowhere to admit a patient from the emergency department.
Sixty or so candidates, ranging from medical student to consultant across all specialties, split themselves into six teams of 10 and studied in detail the bed-blocked ‘Cottage Hospital NHS Trust’. The 'board' had tasked them with finding a solution to the problem now and in the longer term, with an entirely unreasonable deadline of 30 minutes to prepare, after which they would present to the Hospital’s board à la Dragon’s Den in a bid to implement their template to save the NHS. The winner got a box of chocolates (and the unconditional adoration of their peers).
I would like to say the board were a reasonable bunch (once upon a time), but the stresses of targets, finances and ideologies had left them somewhat disenchanted. Though they approached these meetings with a hint of ‘going through the motions’, they were pleasantly surprised with what they heard. Before we hear the radical ideas that were put forward, let’s learn a little about the board:
Dan Fountain - having once worked in the City and now based in Cambridge, Dan cannot understand why places sometimes close outside of London. As the NHS ‘never sleeps’, this was the obvious place he’d end up.
Jake Matthews ‒ an academic powerhouse from Birmingham University, whose real-world QI initiatives are essentially fuelled by abstract submissions to every conference happening in the UK at any given time.
Tanya Holzmann ‒ an ENT registrar, who has done so many out of programme experiences, that the last time she was a House Officer, aseptic surgical techniques were a ‘new fad’.
Gareth Hynes ‒ the methodical respiratory medical registrar who outwardly appears nice, often meaning people don’t think he could possibly be a medical registrar.
Sarah Curtis ‒ a medical student leader who has the pulse of her people. Efficiency largely derived from controlled panic. Zero tolerance of ‘lad culture’.
Kaanthan Jawahar ‒ overly sarcastic psychiatric trainee whom no one can quite believe wants to be a psychiatrist, seeing as he spends most of his time doing nephrology locums.
Given just five minutes to present (including questions), the creativity and understanding of the ‘bigger picture’ demonstrated by the six teams was astonishing. Highlights included:
- An identification that medical staffing issues out of hours often meant discharge reviews frequently fell to the bottom of the pile. An effective, quick QI project aimed at junior doctors involved a weekend plan sticker in the notes detailing diagnosis, management and discharge plan (if relevant) over the weekend, and would, in theory, expedite a discharge review in a safe manner. A beneficial ‘side-effect’ would be better patient care as the on-call team could quickly understand the patient’s journey.
- A discussion on whether medical/surgical registrar reviews in A&E would stop inappropriate admissions. To trial this, a locum (finance pending, which they had actually costed against bed days lost) would be in place for a month doing such reviews, with prospective evaluation of its success.
- Involving all stakeholders, including patients and other healthcare professionals, in discussions on what they feel the barriers to patient flow are, may well highlight items that doctors simply would never have thought of. This would run in parallel to immediate implementation of QI initiatives.
- A boisterous team had a private contractor enter the hospital, consisting of a consultant, OT, physio and social care representative to expedite safe discharges. They were ready to enter ASAP, though the costing of this was an elusive point, but offered several performance-based options.
- A similar suggestion utilised current staff within the hospital to assess the frail and elderly, and expedite care packages or transfers to intermediate care where appropriate. The costing and implementation of this service was incredibly detailed given the shortage of planning time before presenting to the board.
The board agreed to back the final point, shocked by the level of consideration the group had given to their initiative. It was championed by Jonny Holley (T&O CT2 and recently appointed to the National Medical Director’s Clinical Fellow Scheme), though it later transpired he had simply plagiarised this system from his current place of work.
We let that slide though as it was technically sharing good practice. He very much enjoyed his chocolates.
On a serious note though, facilitating this workshop was genuinely exhilarating. I was in a room for two hours with more than 60 enthusiastic healthcare professionals, from all grades and specialties, with an appreciation of the bigger picture embedded in the intrinsic values of the NHS. The persistent criticism the NHS receives often disenfranchises its workers. Paradoxically, I feel this is what drives me, and, it turns out, 60 other people on a February afternoon in Manchester.
Keep the criticism coming; we’ll prove it all wrong.
