Shadowing a Senior Medical Manager; the experience of a higher trainee

I was recently privileged to shadow Dr Fiona Mason, the Chief Medical Officer of St Andrew’s for a week. St Andrews is the U.K.'s leading charity providing specialist NHS mental health care, an independent national teaching hospital, and an employer of over 4000 people. It spans across four major centres in England.  I accompanied and observed Dr Mason, as well as several other senior directors within the organisation. The wide variety of meetings I attended included managerial board meetings, quality and compliance meetings, and even an LGBT (Lesbian, Gay, Bisexual, Transgender) meeting; the latter involved liaising with a representative from Stonewall, in view of improving St Andrew’s already laudable position in the Workplace Equality Index. I also had some 1:1 time with Dr Mason to enquire about the inner mechanisms of the charity.

I was struck by the grand surroundings (the buildings were developed on over 200 acres of Northamptonshire land over a period of 175 years), as well as the professionalism and efficiency of the organisation right from the outset. For instance, on my arrival the receptionist expected me and knew my name. Every single meeting ran on time whilst covering  large volumes of material for discussion. Each of the managers seemingly had in-depth, intricate knowledge of each other’s areas of expertise.

The volume and complexity of managerial issues were striking, and highlighted the necessity for thorough background understanding of health care issues, even though some of the participants had little or no clinical experience. This is especially pertinent within the current ever-changing fluid landscape, with St Andrew’s undergoing major expansion and reconfiguration, and with palpable external influences, such as CQC inspections. The plethora of issues tackled were disparate; from mental illnesses and forensic risk issues, to CQC and NHS England’s standards and targets, to the use of safeguarding coding. I was struck by the level of assiduous detail and scrutiny of every topic, and the cultivation of a  culture of enquiry and improvement.

I witnessed several unique innovations, and heard about others. These included paperless meetings using laptops, utilisation of an appraisal system for all staff directly linked to remuneration, and also socially altruistic initiatives, such as donating the use of conference rooms to local humanitarian organisations, including Rape Crisis and Alcoholics Anonymous. New ideas and talented individuals are not only encouraged, but are actively pursued.

I was also fortunate enough to attend Workbridge, a department of the charity offering vocational pathways and meaningful activity for people with mental health needs, learning disabilities or brain injuries. Here, former  and current patients work alongside individuals referred by social services on a number of different manual projects in a professional environment, which included a pottery workshop, a printing press, and a fully functional garden centre. This is a unique and commendable innovation that affords participants an opportunity to develop team working, technical dexterity and life skills, within a safe relaxed environment. Workbridge contributes to recovery, rehabilitation, and a real opportunity at future employment, often elusive for this coterie of stigmatised and marginalised patients. Just as impressive, is its own financially viability, from its various funding streams. The end products were of such high quality, I could not resist the temptation to purchase a printed canvas myself, which now adorns my living room wall.

The types of clinical and managerial healthcare issues highlighted seemed very familiar from my experience of working in the NHS; e.g. safeguards against medication errors, mandatory training schedules for staff, recruitment challenges, and scrutinising the physical health of psychiatric inpatients. However, the voraciously efficient work of the teams and the methods utilised to ameliorate these issues, all seemed novel.

The experience of shadowing was fascinating – to witness this well-oiled, adroit machine move so fluidly and rapidly, interminably striving to seek out weaknesses and improve standards. I was initially trepidatious; anxious that some of the acronyms, and jargon fuelled concepts would escape me. However, this happened very rarely. As far as possible, my chaperones were very accommodating by ascertaining the gaps in my knowledge, and filling them in. The people I met were remarkably approachable, friendly and the organisation was accommodating; from being chaperoned to a daily complimentary lunch to being loaned my own office.

As for demonstrating the format and processes of upper medical management as a future occupational direction, the whole experience made me more cognizant of the necessary elements, competencies  and characteristics. I could see myself adapting to some of these more easily than others. As junior doctors, we have limited exposure to high level managerial roles and responsibilities, though they are becoming a ubiquitous expectation. I would highly recommend shadowing upper medical management, especially in a large, reputable, successful organisation such as St Andrews. A fortuitous request could lead to an opportunity to step into the world of somebody like Dr Mason.