Don’t just leave the NHS to the next generation…

As a disproportionate amount of my blogs do, it all starts with a tweet.

I unfortunately have a few issues with this concept of “generational” fixing

I think it is ‘our’ problem to fix, but by our I mean everyone in the NHS. The quality, safety and financial issues facing the NHS are not paradigms to be tinkered with, appreciated to be difficult to redress and then passed on like a parcel (not sure anyone would want the music to stop on them). Virtually all journals and health organisations have had a commentary on the reasons why you should listen and engage with junior doctors – the latest from the HSJ “Why junior doctors are innnovation leaders” , but there are many others on [1,2,3]. I’m afraid that will have to suffice as ‘evidence’ the engagement with a future workforce (and not just medical) is a valuable exercise – if you disagree it might be a blog for another time.

The thing that really gets my back up though is the presumption that junior/trainee/developing health care professionals are always given opportunities in change or quality improvement exercises. Need to be clear here: I am not talking about leadership development on a grand scale – not all junior doctors need or desire to have the skills to become operational managers or involved in national projects. I am talking about taking things beyond simple audit (which trainees have experience of in abundance) on to process change, at however small a level, with the purpose of improving quality of care. If you haven’t already done so please do read the blogs from Dr. Partha Kar which cover a wide range of issues. At the centre of many, though, is the notion that nothing will change unless individuals stand up and be counted. You can blame others for current predicaments but no-one will be able make a difference unless YOU do. This philosophy was also espouced at the recent Agents for Change “Speak.Act.Lead” conference. The challenge is how juniors doctors (or any health care professional in training..) can most effectively do this.

For me any health service has a duty to help support its next generation. However, I am not sure how in environments which lack leadership or role models this can really happen. Gilbert and colleagues, in an admittedly regional survey, determined 91.2% of respondents have had ideas for improvement in their workplace; however, only 10.7% have had their ideas for change implemented. Many possibilities for this – ideas actually weren’t any good, junior doctors weren’t persistent or had a poor implementation strategy. I am willing to bet though, having both experienced and heard reports of this, that in a number of cases the barriers were beyond the means of the junior doctor to breakthrough. And more that than there may have been negative influences preventing even initial initiation. I am not naive, anyone at any level may have difficulties with leadership or quality improvement. Junior doctors certainly do not have an monopoly on change challenges but their experiences during training will have profound implications for the future. So I am more than willing to challenge negativity from trainees who feel they can’t get anything done but I must equally fight the lack of opportunity that comes from their seniors and management structures.

This is not universal, many organisations/individuals are clearly supportive, but others aren’t and these outliers won’t be changed by junior doctors alone. I hope I am not a lone voice in this regard [4] as it is not just the next generation that need to Speak, Act and Lead

[1] Coltart C, Cheung R, Ardollino A, et al. Leadership development for early career doctors. Lancet 2012; 379: 1847-1849

[2] Warren O, Carnall R. Medical leadership: why it’s important, what is required, and how we develop it. Postgrad Med J 2011

[3] Involving doctors in Quality Improvement. The Health Foundation

[4] Roland D, Warren O and Klaber R. Engaging with leadership learning in the workplace. The Lancet 2012;380(9841) 563

2 thoughts on “Don’t just leave the NHS to the next generation…”

  1. Agree. The gap is not a lack of ideas or evidence, it is a gap at the implementation step. The tools and techniques for doing this are not taught in medical school or in manager school so we are driven by disappointment to the incorrect belief that it is difficult or impossible. It is not – when you know how to do it. The methods are easy and quick to learn and they are called “Improvement Science” – the “missing link between research and audit”. Unfortunately there are very few books or university courses yet – so I have been developing online training for anyone who wants to get started. – why? Because no one else seems to be doing so and our patients and our profession cannot just wait and watch. The sooner we learn the “how” the sooner we can collectively make a measurable difference in reality.

  2. The benefit of encouraging juniors to do this is that they don’t need to be told “how to do it”, they’ll look through the management structure and just want to change something. The worst outcome for this would be if it ends up like audit: junior doctors used as papermonkeys (usually in their own time) so that Trusts can comply with “standards” without any discernable impact on patient care or perceptible impact on outcomes

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