Sunday, June 22, 2014


It's a thought which came into my mind while having a discussion with some trainees. Going through the e-portfolio, you have to admit it's a chore and there are numerous seniors out there secretly grateful they didn't have to do anything as onerous as this..however beyond that, whatever be the motivation of educationalists (and there are some debates about that) there's no denying the numerous and rigorous testing of ones competence junior docs have gone through. "Have you done enough procedures?" / "Have you got proof of that?" / "What do YOU self assess yourself as regards competence in that procedure?" / What does your supervisor think about your competence in that supervisor?"...endless..all in an effort to root out the Shipmans of this world. 
A person who was a psychopath first, a doctor second- but came to be the harbinger of all that's evil about doctors..those uncaring fiends which had to be rooted out. ..the irony probably being that Shipman would possibly fly though an e-portfolio- eyes closed, undetected. Anyhow, I digress.

If you look at Consultants, yes, it maybe flawed, yes, it could be used better..but performance management is a buzzword which has stuck in the NHS and raises different levels of hackles. "Have you started your clinics on time? / Have you finished your theatre list too early? / What's your LOS?"..I won't discuss how blunt those tools are in this blog's an example..recently a manager asked me what time I started and finished clinic..he opined it was less than the 4 hours of a PA. I pointed out that I also had 20 adhoc slots through the week- which equated to not just an hour but more than that..put in place to help adolescent patients who couldn't attend at times of my choosing but would rather at their choosing. Patient choice anyone? He understood but felt it would be easier for him to collect his data if I didn't do these adhocs...I am older a polite smile and a firm no is what he got. 
Did try to point out that whether I am good or bad as a doctor also had to be measured by what patients thought about me (both paper and on-line link available to view); what my colleagues thought about me (360 appraisal available), what outcome measures such as admission to hospital for the adolescent patients were (again, publicly available)..Ah but I digress again.

So to the basic initial do you measure the competence or lack of a non clinical manager? I tried on twitter, lots of ethereal answers, lots of intuitive thoughts, lots of well respected and leaders with their thoughts..the end product? Actually very little.The question has to be however why that is the case. Does this continue to engender the feeling of "them" and "us"? Is it blasphemy to suggest that the managers, who perhaps rightly or wrongly see themselves as the guardians of public tax money which the nefarious, wine swilling, lazy Consultants are frittering away are scot free of any scrutiny themselves? Or is that there is something robust out there which I am not aware in which case I profoundly apologise publicly to all managers for the frivolous nature of the comment above?

I have seen plenty of managers in my time as a clinical manager- some "good", some "ordinary", some "awful"..aha...I hear you did you know what they were? One characteristic stood out...listening. Listening with one thing in mind..improving patient care..and I am afraid not all do. For some its about meeting a target, a number...and if that's what they are judged on, then I understand the reasons why. When your job is on the line- whatever your profession, patient care related evangelism seems to drop down the agenda- nothing wrong with that- as its easy to criticise from the outside when YOU are not in the same position...but it again suggests that the markers to judge the manager, if indeed they do exist, is wrong.

So, as I laze on a Sunday afternoon, I ask all the leaders, all the bodies, NHS Confederation, NHS Graduate Management come up with something which could be useful. Something which ties in with what the clinicians are trying to do- and makes all sing from same hymn sheet. Something radical like perhaps measuring the TEAM- consisting of the clinician and manager- on patient outcomes, feedback win accolades and awards together, you also take the criticism and fallout together.

Till that day, till you have something unified, till the day we have clinicians being measured on targets they haven't helped design- and the right or wrong impression that managers are running doesn't matter how many courses you run on teamwork or group hugging, the NHS will always be divided into "them" and "us". If the driver for different members of the teams are different, then there is no chance of those teams pulling in the same direction. 

So..who wants to work on that with some clinicians? I am game...anyone interested or rather just be scot-free?

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