Monday, February 29, 2016

Stick or change?

At what point do you call time? I mean on a project? An initiative; intervention;campaign...whatever you want to call it...at what point do you say...umm..maybe we should try something else? I am talking about leadership courses/classes/degrees/conferences etc. I have never been a big fan of them but have always been willing to see its input and outcomes...problem is what do you define as outcomes? If you talk financially, then on one hand you could say its an abject failure- but then again, would you call Tony Pulis a failure if he doesn't win the League at West Brom- or would you say he's done a great job with the resources he has? Tough, isn't it?
Outcomes? Well..if one looks at something closer-lets say diabetes, thats a bit - whats the word..ah yes, awkward- have our leaders failed us, have they failed the patients or have they done as much as they could have done?

I will put my hand up- I haven't done much leadership courses- and have been roundly mocked by some senior leaders for saying so. Maybe thats why I have yet to put "leader" on my CV- but either way, be it by design or fault, I haven't done any. I learnt more about leadership- ability to negotiate, complete tasks by doing research. That's not to denigrate anyone who does it- but simply to state what I haven't done.
So back to the question- do we call time on leadership courses? Some say they are quangos feeding off the public purse, some say they are building generation next. Question is- in cash strapped times, should they be funded by public money? Has it had enough of a run or is it time to mothball this project?

A very notable personality once upon a time used me as an example to differentiate between a rebel and a troublemaker. You know that chap- Gandhi- a right troublemaker for the British Raj- todays quintessential rebel leader- funny how history changes its views on individuals., isn't it? What about leadership based on values- its all about perspective of values,isn't it? Its yet another mystical term...again- my apologies- I haven't done those courses - so perhaps not au fait with the terms and terminologies- but as someone who is paying his taxes, simply would like to know the return on investment. Healthcare leaders are supposed to inspire I am told, lead many..or even simply show vision, shape the future- all with one and only perspective- improve care of patients- right? Are we doing well on that front- or is it simply lack of leaders which is the problem?

The word system based leaders is the new term- an ever growing need for it...so here's your conundrum, how do you change the focus of leaders who have spent years thinking of their own Trusts fame/fortune/bottom line- and get them to think of the community; get them to consider shifting money to primary care- even at the detriment of the Trust they hold so dear? Can you actually do that? Or is it a pretext to ask those leaders to actually take over others and bring all under one roof- is a system leader who can bind all irrespective of their employers or is it someone who fuses them all by ruthless takeover?
Are the Dalton Chains about system wide changes- or powerful Trusts joining hands and taking over primary care? System leaders- depends on how you see it, right?

So have a think- have a wonder- and see whether to be a leader you need to actually do any of that- or whether it sits within you to make the change.Its always a tough call- the question is whether that is possible or are we underfunded to a degree that no leadership can turn this around? I don't know is the short answer- but the lack of results from the usual leadership cohort is turning a whole generation away from the "hallowed land".

Time to change or continue doing the same? Or time to learn from some leaders who haven't necessarily done any courses etc? Have a look at those folks called junior doctors. Star Wars was all about better leadership in the Rebel alliance...right? 

Tuesday, February 23, 2016

Easy Rider

You have to wonder what's the path most choose. When faced with sticky situations, if given a choice, would it be the easier one? Or the one with troubles ahead?
Let's forget the inspiring tweets and speeches as regards the greater good but for the average person, beyond their personal zeal to help humanity, there also exists a family, a life and a desire to have a hassle free existence. Lets forget the example of Gandhi dropped at a hat by many, who also tend to forget the mans lack of family life to compensate for his zeal to deliver independence to India.
It's sometimes difficult to have that conversation in the vortex of leadership cults, especially within the NHS, who all seem to have an opinion about how other should lead their lives. There also seems to be that accusatory stance that if you haven't stayed on late, burned yourself that extra bit..then perhaps your vocation isn't strong enough. Those flippant comments about women having to leave early to pick their kids up...how dare they choose such a course when they should have stayed there and left their kid standing at the school ground wondering where his or her parents were. A scared child? Well what's one or two of them compared to healing a few more people. All for the greater good, isn't it?

It's odd, very odd  to see that attitude which has seeped into the NHS consciousness nowadays, driven a lot by many who themselves have got to a position where either they don't have a family or their family have left- look at Twitter, it's full of sanctimonious comments about the greater good- and it does get a bit nauseating after a bit.
I will be pretty honest, I get paid well, I try and put in a hard yard when I am at work, do my job to the best of my ability but no kid of mine will be left crying on a school field. Ever. And if that makes anyone think I don't have this mystical quality called vocation, so be it. Vocation doesn't pay your mortgage, school fees or more importantly, offer anything extra when you turn around to see your kids grown up and ready to leave home. The time spent on vocational work..sadly time lost being a parent too.

The same situation plays its part within the confines of the darkening mood of the NHS. As central grip tightens, the fear factor is there to be seen, Anything mentioned even in passing, even constructive criticism is seen as dissent. The story of the whistleblowers lay out a damning indictment...many a committee, many a panel, many a report later....many careers lie ruined. What lesson does that leave for anyone trying to raise any questions...Yep, it's the easy option out. You have two paths to choose....one is going against the establishment, voicing concerns, channeling your vocational element on behalf of the patient and risk it all....or you could keep our head down, do your job, go home and pick up your not too insignificant salary as a senior in the NHS. Why take the hassle?  Be the Easy Rider says the mind.

It's no different for leadership positions either...look at any report, it says the same thing..there aren't many good ones around. 2 obvious reasons stand out for it in my opinion. First, the attitude of the NHS towards it, continually seeing it as an extra rather than an important role and secondly, the inability to define the why. It's much more convenient to take the Easy Rider option. A good salary, a good pension, a few weekends work..why would you take the extra work? To many leaders, such thought is blasphemy...but once again, they perhaps forget their present position, they forget not everyone may share their zeal..and they forget leadership can't be taught in a classroom.Its very romantic to be able to take the harder option, build a story of battles fought, dragons slayed but one forgets that for many it is about just being a good, kind doctor for the patient in front of them and then going back to their families. Not everyone wants to be a leader, not everyone wants to sacrifice their lives to the cause of the greater good.

As time has passed, you can see the vocational aspect being slowly squeezed out..as I always say, you can't force vocation on anyone. Unhappy staff don't give vocation, they do their bit..and they go home. So NHS organisations and national bodies,if you want to squeeze that extra bit out, or look for transparency or even look for leaders to step up, think of how attractive that option is. You can't bark and ask for vocation; You can't threat and ask for transparency; You can't demand for leadership if you harp more about failure than success.
Think again...the key lies in the workforce...don't make them into Easy Riders.

Friday, February 12, 2016

Sizzle and Burn

The whole world has gone bonkers. Absolutely. And totally. If the fiasco over the junior doctor contract unfolding over social media wasn't enough, it stepped into a complete zone of surreal idiocy beyond comparison as of yesterday. People were so angry that they even forgot who was on whose side..cross fire, lateral fire, friendly fire...it would have been hilarious if it wasn't for the future of so many bright folks at stake.

Lets get one thing off the bat first and foremost. There is a heck of a lot of twaddle that this isn't about patient safety but about just pay. Well, even if one leaves the safety argument aside for a moment, then let me tell you why this is about patient safety...IF THERE ARE NO DOCTORS IN THE JOB, THERE ISN'T THE PERSON NEEDED TO SEE THE PATIENT. Sorry- I will stop shouting but when I hear that line of "it isn't about patients", I want them to come with me and see the vacant slots on the rota we are having to fill, failing and then praying all will be well. Its a bit like saying that the tube drivers strike was all about pay, nothing to do with the public. Umm...yes it was- as without them, the tubes wouldn't run- causing inconvenience to the public. A lack of doctors doesn't cause "inconvenience"- it causes harm- stop dancing around that, stop trying to say others can do their job- no doctors = harm. And yes, same as nurses- less nurses = harm.

Then we come to Dalton. Now I must confess I had no idea who he was- till he did the Dalton report. He is known to be a system leader- it is reasonably easy to spot them in the NHS- they are white and male-and many I respect tells me he is a man of integrity. I haven't met him so won't and neither should I pass judgement- but I read his Dalton report. It said all the right things- things I liked hearing but perhaps something anyone working on the coalface could have told you over a pint of beer.

Anyhow, he tried, negotiated with BMA, then got fed up and said Impose it. He said he had support of 20 Chief executives- of which by time of writing this blog, 14 had said..Not me bruv.
Well, that went well then- episodes of the Thick Of It came rushing back to my mind. Buoyed by this mystical support, Mr Hunt went and did it and unleashed the hordes of fury, anger, disappointment.

So now where to? Not about patient care? Well- tell me that when I don't have a junior doctor to cover areas or stretched to their limits and beyond as the umpteenth locum hasn't turned up. The suggestions are all becoming even more ridiculous by the moment- train more, some shout...with what? Monopoly money? Then there is the small issue of the junior doctor issue being mixed up with those who simply don't like the government. Now this is also very confusing...I supported the junior docs and I was called a leftie..I can assure you that any Tories digging into my past would be very surprised then. Then I got called a champagne socialist- that did make me chuckle as I had tweeted many moons ago about my dislike for them- and managed to offend a fair few good people. Then...hold on to your flipping horses, I supported a cross party commission and I was called a neoliberal. My apologies but I don't even know what that flipping means. I do know that you cant be a neoliberal, leftie,champagne swigging socialist at the same time. I think. I would like to add that the majority of people supporting junior doctors don't actually fit into any pre-ordained boxes.

So I will tell you what I am. I want care to be delivered free at point of care- irrespective of the patients ability to pay. I change my vote depending on policies but I want to improve care- and what Dalton and co have done will not do that. I am and will continue to try to improve care- but I need my junior doctors- happy and ready to give that extra 5/10% when asked. Because the NHS needs that extra to function well- and deliver good care. I don't want them to be bitter and angry- I don't want to give them a hug and see someone struggling to hold back a tear because one man's ego was too big. I don't want them to think managers are against doctors- as they are not- they are hard working staff without whom clinical care are impossible- and NHS Providers may ask for imposition- but they do NOT reflect every single manager or Trusts view in this country. They do not.

We recognised where we work that 7 day services were needed for diabetes patients. Data told us...most importantly patients told us- so we negotiated, we cajoled, we worked on it- and delivered it  with extra resources. The result has been a drop in errors and happier patients.

To all those who genuinely want improved patient care, take time to reflect and think how in the 21st century -imposition is fundamentally wrong. Think what you will say when you use that powerpoint slide on staff engagement....believe in it genuinely. Otherwise, in the times of history, you let us all down.