Leadership

99 problems

This week I was sent the ‘imatter’ questionnaire to complete.  It’s badged as a  ‘staff experience continuous improvement tool designed to help understand and improve staff experience’. In other words it’s a cultural snap shot.

There are many ways that organisations will try to gather data on the prevailing mood and climate. However I believe if you truly want to know what the culture of any NHS organisation is then I suggest looking at their education departments.

Education and culture have a symbiotic relationship. It’s something that the GMC believe is important too but do we really understand what it means?

Take a superficial look and yes you will be told that most healthcare workers are supportive and approachable.  Yet something still feels off.  Reflecting on the various trainee surveys the things that are consistently highlighted are around this idea of culture, the learning environment, communication and a feeling of inclusivity.  This is mirrored in the trainers reports as well.

So there is something of an irony that as we live in a time of greater connection through social media, email etc we continue to feel isolated.

So how do we bring a sense of community back or joy at work, if you will?

I believe it begins with the culture and at its core, organisations placing a high value on education and training. It also requires organisations to recognise the multi faceted nature of the problem

Take for example educational supervision. In many organisations there is an imbalance between number of trainees per trainer. We need to look at ways to not only encourage more people to become trainers but for them to feel supported in this role.   To my mind that comes from providing courses/time specific to the needs of local trainers.  Currently people are forced to go elsewhere – assuming they can given the current service pressures. So it makes no sense to me why there isn’t better local Faculty Development to make it easier for people to access these courses.

Another hugely important area is to better engage with our primary care colleagues.  They are renowned for delivering excellent training but again remain isolated and disconnected from secondary care.  I believe that through more collaboration we could share learning on every level from how to deliver training but also in shared educational events. In my experience, these type of events lead to better understanding, more collaboration and adds to a more inclusive culture.

Our medical students also play an important yet understated role in the culture of the local workplace.  They may appear on my ward rounds but I rarely see them elsewhere.  This isn’t meant as a criticism but I do wonder why they aren’t made to feel more part of the team?

I also spend a lot of time listening to our trainees and they tell me that they feel our particular hospital has something of an identity crisis.  It may be a District General but it has the workload of a tertiary centre without the workforce to match.  Why is there not more trainee advocating going on?  This may seem a trivial point but again it does have an indirect negative affect on the culture.

We have Realistic Medicine to weave into not only the content but the delivery of our education and training programs. To do that we need to be more forward facing and flexible.  Part of this will come through working with colleagues in e-health. We should be more creative in the ways we deliver our traditional CPD – not just face to face but stream or record them for people to watch at a time that suits. Podcasts would provide even more flexibility.

However motivating a workforce that feels somewhat downtrodden under the weight of the service is perhaps the biggest symptom of something not being right.

So you can carry out survey after survey but if your organisation comes back with 99 problems and education ain’t one of them then you have a much bigger problem….

Leadership, Uncategorized

Everything is everything…

So I’ve been a bit quiet of late on the blog front.  My head has been rammed with all things work related specifically the medical rota.

I don’t think it’s any secret that things had not been going as well as we’d hoped. We had (and still do have) significant staff shortages. It was becoming a total nightmare trying to balance training, education and service delivery.

It all came to a head a couple months ago and what followed were some uncomfortable but honest conversations.

I took over the day to day running of it.  First up was trying to get clarity over what needed doing first. I set about distilling it into short, medium and long term goals.  That was the easy part however I had forgotten to factor in one thing:

It turns out some people do not want problems fixed.

Yes, it’s true!

This is not a new phenomena either – think about all the projects you’ve tried to get off the ground or change you’ve tried to implement and you’ll know it’s true.

Now of course the trainees wanted it fixed as did some other like minded folk but very few other people did.

To start with it confused me. Perhaps naively I hadn’t appreciated just how many people merely talk a good game.  You can usually recognise them by their passionate agreement with everything and anything followed by doing nothing.

Then you have the people who are downright obstructive either in their behaviour or use of bureaucratic process.  This makes me angry.

At the point where traditionally I say ‘stuff it, I’m off’ I chose to dig my heels in and work harder.

It has made me hugely unpopular at times and probably damaged a lot of my working relationships with colleagues.  However things could not continue on a downward spiral.

To that end I have taken a rather detached but objective view on things. There have been some overwhelmingly positive things to come out of the work so far. Some of which I truly believe have the all the hallmarks of culture change.

There are some who have really stepped up and are effecting this much needed change.  Having the trainees involved in the rota management has been key.  We meet every week to work thorough the issues. The process is still being refined but it is starting to become more slick.

One of our early success stories is the WhatsApp group to help share information and deal with urgent issues in real time.

I also send a weekly rota update to my Consultant colleagues and the wider trainee group.

There is even representation from the management team at our rota meetings.

I know there are those who continue to be unhappy about the perceived lack of progress.  There will also be those who use the rota to push their own agendas, blaming everything on it.  Some are simply furious for all their perceived loss of power and control.

Personally I can see a glimmer of light creeping in through the thorny trees of a dark wood. It is also now that I can allow myself some breathing space to pause and reflect on where we are and where we need to go next.

The path is becoming clearer. It is one where everyone is now much better equipped with information and support.

We just need to keep going, forging new paths before we ultimately reach our destination….

Leadership, nhs

Music

Up until this week I’d considered the concept of ‘team work’ to be within the context of sport. Organisations such as the NHS have also adopted it however I’d never really thought about it within the context of music.

My daughter has recently started learning the glockenspiel and plays in the school band.  She’s pretty good – yes I’m bias but she can play the Star Wars theme tune note perfect and with no sheet music. Come on, that’s good!

Anyhow I digress…. The kids have a completion coming up so having been rehearsing hard.  This particular morning the parents were treated to a performance of how they were getting on.  At the end the teacher explained to us some of the non technical skills they were learning in addition to the actual music.

I found it fascinating.

There were 5 main features:

  1. Focus – the kids were told to ignore any waving or shouting from the audience. By ignoring any distractions they were to walk to their positions looking professional. Focused on the music ahead.
  2. Tempo – each piece of music has a particular speed restriction.  Knowing it means everyone in the band adheres to it, neither going too fast or too slow.  The team goes along at the correct speed
  3. Leadership – keeping an eye on things is the band leader or the conductor.  The band members are advised to look to the conductor to ensure they are playing at the correct speed and at the right time.  The conductor themselves has the job of keeping everything harmonious and on time.
  4. Vision – is it what the composer wanted? Does it sound like what was envisaged for the piece.  The conductor can only do their job right if the various parts have the correct notes, in the correct section and aligned perfectly.
  5. Resilience – when it all goes bit pear shaped can you listen to what’s going on around you to pick it up again?

Point 5 I found the most interesting concept. It essentially spoke to me about the idea of silo working that I’m seeing at work.  What I liked about it in this context was while everyone has their own part/instrument to play, they are taught to listen to the other band members to guide them when they get lost or play a wrong note.  They don’t just give up and stop playing.  They get right back into the music and continue to contribute.

I think we need more of this in the NHS.  I do accept there are those out there trying to do this but they are still in the minority.  I have yet to fathom why.

While I was mulling this Kenny Dalgliesh came on Sunday Brunch.  Amongst the many questions asked of King Kenny (my husband tells me I’m legally required to refer to him by this name) he was asked what is was like to change from being a player to a manager?

In his very matter of fact way he explained that essentially he wasn’t part of that world anymore.  He noted that when he’d walk into dressing rooms the conversation would stop.  It was fine though.  He understood the change from playing with your mates to being the one who makes the tough decisions and enforces the rules.  Sure you can have the banter but at the end of the day the players look to their manager for guidance.

I see this in my work.  I am the big bad rota meister. I am also the one who constantly goes on about having structure and action plans. I am the one who walks into a room and the conversation stops.

However these days I have a choice of rooms to go into.  There are some that require the direction of a conductor.  And then there are those full of composers trying to create the vision.

At the end of the day the choice is clear for the NHS – we can collectively create beautiful music or continue to tolerate a big old noisy mess.  I am optimistic that the answer will be music to our ears…..

health, Leadership

Run the World (Girls)

This week was the Centenary of the Medical Women’s Federation.  Although I couldn’t get to events down in London Izzy Utting, an Edinburgh medical student, had organised an event entitled ‘How to have your cake and eat it….’ With actual cake!196048

 

 

 

I was asked to speak partly due to my role in the MWF (secretary Scottish Standing Committee) but also as someone who has apparently achieved some degree of success as a female doctor.

This I had to smile at that.  ‘Me? You sure about that?’

Preparing for my presentation I couldn’t feel any less inspirational or motivational.  I did seriously debate putting a slide up with:

‘You’ll figure it out’  (drops mic and walks off stage)

Ahead of me were two amazing women Dr Sarah Stock (@evbasedbaby) and Dr Rebecca Heller or Bex (@rebeccalily) talking about their career.  While there were stories of inspirational high achieving women they were both refreshingly honest about some of their life choices and career failures.

Although our talks were prepared independent of each other there was a recurrent theme – Imposter Syndrome.  That nagging irritating voice in your head that tells you are a fraud. The one that causes everyday to be spent in  state of anxiety worrying you’ll be exposed as a charlatan.  I must say I hadn’t actually come across this term until relatively recently but I had experienced all the symptoms.

You see Imposter Syndrome is like a parasite – feeding off your insecurities and self doubt.  It messes with your head so that you are unable to recognise other women going through the same thing. And let me tell you they are.  It’s just it makes you believe that the first rule of Imposter Syndrome is: You don’t talk about Imposter Syndrome.

Bex shared the statistic from an internal report for Hwelett-Packard that men apply for a job when they are 60% ready compared to women who wait until they are 100% ready (Sheryl Sandberg, Lean In). I think this probably tells us all we need to know about its destructive power.  I’m also pretty sure this is why only 24% of Medical Directors are women too (Kings Fund).

So I decided to face mine head on.  A parasite only survives if you feed it. Or in the words of Maya Angelou:

34643-Maya-Angelou-Quote-If-you-don-t-like-something-change-it-If-you

So I stood up and talked about how I had failed. Quite hard to do as a control loving, micro managing perfectionist. That said I made it sound as spectacular as possible – old habits…..

I also talked about what I was lead to believe were terrible career choices.  For example starting a family as a Registrar – something only a handful of people did at the time.  I was also told not to go part time because ‘you’ll never get a Consultant post’.  And for goodness sake what was I thinking about going part time again as a Consultant.  Apparently you’re meant to increase your work load at this point.  Life it seems can wait until you retire.

This is simply not good enough.

So what did I tell these young women:

‘You do what’s right for you at the time’

That means:

  • You will make mistakes – it’s ok you will learn stuff from this
  • You have the right to change your mind
  • Trust your instincts – especially when taking advice.  That person may only have their own interests at heart, not yours.

So can have your cake and eat it?  Yes. Absolutely. And I encourage you to try every single one….

Leadership, nhs, Uncategorized

Everything is awesome

I have always considered myself a positive and naturally optimistic person but several events this week sought to test that.  To be fair some were truly awful. However there were some things that, in my opinion, restored an equilibrium.

The first was the news story about mental health as championed by William, Harry and Kate:

https://www.theguardian.com/society/2017/apr/17/prince-harry-grief-revelations-praise-mental-health-experts

I quite liked the honesty with which they talked about the British ‘stiff upper lip’ culture. This is such a ridiculous notion when faced with the tragedy of losing your mum at such a young age.  There is no silver lining or looking on the bright side.  It’s just bloody awful and should be treated as such.  That said I do think how they have channelled it into something good is remarkable.

https://www.headstogether.org.uk/about-heads-together/

They are not the only people who are able to do such things.  Look around and you’ll see people from all walks of life trying to create something good from terrible circumstances. It could be running a marathon for charity or volunteering.

There are parallels with our daily NHS life.  Recently I helped one of my trainees complete a near miss incident form. There was no harm and the patient and family were informed. The main thing from my perspective was to identify exactly what went wrong and more importantly how to make sure it doesn’t happen again.

The process of documenting failure is, by its nature, long, depressing and overwhelming negative.  There is no way to make it a positive experience for anyone. What you have to do though is pick everyone up and somehow turn it around. It’s a difficult one to balance as you want people to feel empowered to make a change but equally you’re trying not to diminish the mistake in the first place.

I believe we managed to achieve this balance.  A plan was made and over the next few weeks I am optimistic we will have something in place that ensures this particular incident will not be repeated.

Which then brought me to this quote that I saw the following day on my twitter feed (thank you @johnwalsh88): C91f2UvW0AAZKbu.jpg-large

This to me is much more reflective of who I am nowadays. I think it’s what we should all be to be honest. So with the glass half full I would argue that for every situation you hope for the best but plan for the worst.  To me that is about having plan A, B, C, D etc etc

This philosophy is reflected in a postcard I have on my wall at work that says ‘Failure is not an option’  It’s from the Apollo 13 mission. It makes me smile every time.  Now you may think I am deluded or living in denial but I agree with the statement. Failure is not an option.  You just haven’t found the option that works.  It is true of the NHS and in life that you will need to try out many different options until you find the one that works.

So on that note I go into another week with my eyes wide open, optimistic that it will be a good one. If it’s not, well, that’s just a chance to try out Plan B…

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Leadership, nhs, Uncategorized

Enjoy the Silence

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I’m on holiday. Hallelujah!

When I eventually got home on Friday night I felt like I had literally crawled over the finish line and collapsed in a heap.

Cross covering colleagues immediately increases your workload however there is an understanding and clarity of what is expected during this time. My job is to keep our patients safe and lead the team.  I become much more directive Dr Copeland in order to manage my time to its maximum efficiency. This is especially important given I work 3 days. I also expect the team to know their role.  What is crucial is that we check in with each other just to make sure.

This clarification of understanding and expectation is something I do whenever I meet a new patient too. If you don’t and instead assume you will get something wrong.  I’m not talking about clinical mistakes where patient harm occurs. What I mean is the type of mental harm that comes from not explaining things properly or giving opportunities to ask questions.  Most importantly it is about setting expectations e.g. when a test will happen or when you might get home.

It also applies to non clinical situations.  This week I had the joy of manning the middle grade rota for the first time.  When I say manning, fire fighting is probably a more accurate term.  Without getting into detail, there have been issues.  I’ve done rota management in all of my jobs so this one didn’t particularly phase me. Yes, it’s complicated with all the rules around rest days, number of hours worked, days in a row, etc etc but not overly so.  What was surprising to me was the virtual tsunami of emails that came after it was distributed. No one was happy.

After a while a pattern emerged. It seemed to me what was missing was this fundamental clarification of understanding and expectation.  The specifics of promised swaps and annual/study leave requests while obviously important did not seem to be as important as acknowledgement of the request and when to expect a definitive answer.

I have come to hate the ‘death by email silence’ that occurs in the NHS.  In that vacuum a person can create all kinds of scenarios that may (or more likely) may not be happening in response to sending an email.  These assumptions can lead to all kinds of behaviours.  In a rota situation some may take that silence to mean ‘yes, have that week off’. Or it can have the opposite effect so the person can’t get to a family wedding, for example. Either way it leads to both an unhappy workforce and rota management team.  In my experience a simple ‘your email has been acknowledged. We hope to have an answer for you by X date’ can go a long way to defusing a volatile situation.

So as I put my out of office on there is an understanding that I will not be checking my emails.  My annual leave week is a time to relax in the company of family and friends.  The expectation is that when I get back to work I will be refreshed and ready to go again…

Leadership

You cannot be serious……..

So this week was the 15 year anniversary of one of my favourite films – ‘Legally Blonde’. The film follows Elle Wods as she goes to Harvard Law school to Unknown-1win her boyfriend back.

The film at first glance might draw assumptions of chick flick froth and to be fair the first 15 minutes do little to dispel that idea. However watch on and you see that below the superficial pink sparkle are themes about discrimination, prejudice, leadership and haberdashery.

My own personal take is that it is mostly about the multi faceted nature of being female and what it’s like living in a world where you are immediately judged by how you look.  What you say is similarly judged and compartmentalised – Bossy, Ambitious, Part Timer or worse of all Nice.

The film takes me back to the days when at high school the deputy head (who was female) told me several times that ‘Medical School is very competitive. For every one place there are ten others vying for it. You are highly unlikely to get in.’

So when I got 3 conditional offers I was told again that is was ‘highly unlikely’ I would get in.

Hmmmmm…….

Like the skimming stone of time not much appears to have changed.  Today I’m a Consultant Geriatrician working in the NHS. The barriers and obstacles remain but they are more covert.  So the film got me to thinking about resilience.

Its about choice.

You can chose to be miserable and mired at work or you can choose to do things differently.  To put this into some kind of tangible context its worth remembering that for the vast majority of us working to, lets say 65, we will spend approx. 35% of our lives in work. Or as one study quoted ~110,000 hours.

Are you really going to be that unhappy for that length of time?  I see many of my older colleagues coming back to work after their official retirement.  It also makes me wonder about my colleagues who tell me that they just want to retire and have a life. It makes no sense!

Now, to be clear I’m not talking about being sunshine and rainbows all the time. Our job at times is hard, stressful and utterly demoralising.  It is also the most amazing, satisfying and interesting job a person can do and that is why I love it!

There can be prejudice or assumptions that comes with being that positive person in such a negative environment  I was once told that it ‘must be hard being the team cheerleader all the time’. You may be judged as caring less, presumed to be less knowledgable and frankly just not serious enough.

This could be demoralising if it were true and you allow people to project their issues on to you.

But the world needs cheerleaders. Individuals who make being the tough days that little bit better. Smart, fun, serious – multi faceted.

2, 4, 6, 8 who do we appreciate?

UnknownYOU!!!!