Saturday, November 15, 2014

Contract games part 2: Think..TEAM

It always makes me bemused when we talk about yet another contract. We fail to actually monitor, adhere to, understand the present contract so to suggest yet another modification will solve it all is steeped in naivety. Most managers I have encountered have not actually gone through a gruelling course or understanding of the Consultant contract -which isn't their fault- so to expect them to monitor and hold people to account is also a bit simplistic, if not fool hardy. The Consultant contract is fundamentally different from say a GP contract or a nurse contract- so to use the same tools to dive efficiency- if that's the new buzzword - not to surprisingly doesn't work

So to some suggestions- not too radical- and indeed have been tried in some places with good effect- whilst also keeping morale high. But it involves help from both sides- not just managers but also Consultants themselves- the billion dollar question,as ever, is are they?

1. Annualise departmental job plans: 

Put all PAs in one pot- maybe tricky in bigger department but not impossible. As a manager, explain to the team that the Trust is paying for X sessions and thus its only fair to monitor whether X are being delivered or not. Give the onus on the department- we talk about working in teams- well then, give the department the ethos of a team. It's THEIR responsibility to deliver- as a group- let them sit as adults and come up with plans- let them sort their team annual leave, study leave out and outline the sessions they will be doing.
As a manager, don't just rock up and say "Its short guv"- give heads up- send the departmental lead quarterly updates where things sit with sessions- a pat on the back if on track- again- to check internally if short- why short, is there a busy month coming up which will cover the shortfall or is it someone within the team not pulling their weight? Let the team sort it out. At the end of the year, its the team which will be responsible for the outcome to the question- "Have you delivered the sessions the Trust has paid you for?" Together you rise, together you fall

2. SPA time- as a team:

Again, SPA is not some mythical beast. If teams are saying they have, lets say, 12 trainees to supervise- no problem- of course check with the postgraduate lead- as to whether they are indeed the supervisors- and have a system of checking even with the trainees whether they are actually being given the supervision? What's the point in having SPA allocated to your time and then not having time for the trainees if most of the time is in DCC? May as well be open about it- again- let the team choose which members of the team are better suited to deliver training, research...I have been involved with education long enough to know many are not interested in teaching or supervising..so why allocate that in their SPA?

3. Outcomes- as a team:

There;s little in job plans to measure outcomes- why not? To suggestion 1...there is little point in doing all your sessions if the outcomes suggest that you are not benefiting patients- who would I rather have as a doctor- a surgeon who does 5 cases in 3 hours but with a higher mortality than someone who does 3 cases but lower one? If its the same case mix, then its the second one for sure. Think broadly- again- let the department be asked what THEY would like to be monitored on- a team effort- and once they agree- that indeed is the monitoring- why indeed not?

4. Transparency of job plans:

Finally, make all job plans, outcomes agreed- sessions being done transparent. At the moment, hospitals are filled with folks who think they work the hardest and by default everyone else is lazy or at least less busy than them. Its like there's an award for being most miserable, downbeat, looking tired...if you smile and say "it's not too bad"...the immediate thought from the other party is "lazy so and so.lets look at their job plans". Let's make it transparent...just because you work in emergency department doesn't make you less busy than if you work in an Endoscopy suite or Rheumatology make job plans open- let the miserable ones review it and come to a more open conclusion- stop the sniping, make teams expand from just departments to have a more divisional feel

Its about treating adults as adults. Discuss, negotiate with them what THEY believe their outcomes should be, don't foist on them. Discuss with them why they can't work as a team- use job plans to create the ethos of camaraderie- get THEM to rise above departmental disputes. Learn from sports- disparate characters get together to make a winning team- Consultants are no different. But once THEY have agreed to be monitored on X, Y and Z, then give managers the tools and understanding to have regular meetings to discuss them.

We in the NHS have a phenomenal capacity to over complicate things and then to change something which we couldn't implement in the first place. It's not really that complicated- it needs strength, tenacity, determination and a strong feeling of mutual respect.

That, I am afraid, isn't something that we have in huge measures in the NHS- sadly we seem to spend more time thinking of new fancy terms to resurrect old power point presentations. This isn't the time for packaging old wine in new bottles- we need a new brewery.







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