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Your greatest value is your ability to solve problems

As a healthcare professional you may face problems that require problem solving at the least and the generation of creative solutions ideally. How do you hone your creativity?

The results revealed that leadership clarity is associated with clear team objectives, high levels of participation, commitment to excellence, and support for innovation. Team processes consistently predicted team innovation across all three samples. Team leadership predicted innovation in the latter two samples, and there was some evidence that team processes partly mediated this relationship. The results imply the need for theory that incorporates clarity and not just style of leadership. For health care teams in particular, and teams in general, the results suggest a need to ensure leadership is clear in teams when innovation is a desirable team performance outcome. West et al

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How do you enjoy musac?

It’s Friday evening. Your customer, client or patient needs something. You’ve been trying to arrange it or get the necessary authorisation over the phone and now you’ve been put on hold listening to musac. You had advised this person in all good faith that what they need to make a decision will be here today. The minutes tick by and then the phone goes dead. The queue of people waiting is growing longer. A tired child is screaming somewhere nearby and you are already running late.

Over 54% of physicians report a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. The number is up 10% from just three years ago. Who is to blame? If you ask many physicians, the fault lies among leaders involved in healthcare finance, policy and clinical administration. Sachin Jain

You can choose your reaction to the trial by phone on Friday evening. This scenario is not uncommon and as a doctor it won’t be the first or last time you will experience it. Yet each time it happens it may evoke the same negative emotions until you choose otherwise.

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What price do you pay?

Looking back it was the right decision for me. I decided to choose a different career the day I wiped mayonnaise off my tie. I didn’t want to have my meals on the run. The job wasn’t for me if the price was regularly having to eat out of a paper bag rushing around from place to place or sitting at my desk. Others felt differently. I had to make a choice that worked for me.

While 62 percent of doctors who were normal or underweight reported eating a healthy diet rich in fruits and vegetables, the survey revealed that 44 percent of heavier doctors eat a diet high in carbs, meat and fat, or “on the go” meals. Just 16 percent of doctors who were considered overweight or obese were on a diet meant to help them lose weight or restrict calories. Life

Picture by Chris Blakeley.

The doctor is a busy lady

My friend Alex is a good daughter. She would accompany her mother to the clinic for injections every two weeks. They would wait patiently in the waiting room before they were called in to have the treatment. Alex’s mother was a diabetic. Because of her treatment she needed regular meals. At one visit Alex went up to the reception desk and asked how long before it was her mother’s turn.

You see she is a diabetic and needs some food.

The response was jarring:

The doctor is a professor.  She is a very busy lady. She will see you when she is free.

Alex tells me that professor was a wonderful doctor and would have been horrified to hear that the receptionist had been so rude. Do you know what the person who saw you customer, client or patient just before you said to that person? Isn’t it your business to know?

Picture by Ronnie Scotch Finger

Steep hill but nice view

On this beautiful earth it is not long before you have to climb a hill to enjoy the view. Where in your job is extra effort required to get to the end of the day? What makes it harder? Could it be the voice in your head telling you that this particular ‘hill’ was specifically designed to make life harder for you? Is it because you were not anticipating any ‘hills’. Are you on the wrong road? Do you need to get fitter? Is hill climbing not for you? Could it be that the view is not worth the effort?

Here’s a perspective from Jonathan Mead

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The most valuable lesson learned on my first day as a doctor

Picture by JD Lasica

Can the patient relay what was done for them?

A perennial source of dissatisfaction in healthcare (as documented here and here) is the poor flow of information from one sector to another. ‘Joe’ (speaking here– video from BMJ open) couldn’t tell me, his doctor, anything helpful about what had been done while he had been in hospital. That means we have to schedule several appointments to try to unpack it all. He was an in-patient for two weeks and someone had decided one Thursday morning that it was time for him to go home. It wasn’t really clear to Joe or to me why that particular morning or what was to happen when he got home other than that he should contact his ‘local GP’. A letter would follow some time in the future. There may have been good or bad reasons for sending him home. We could only guess what was in the mind of the person who made the decision:

We needed the bed. Joe was fine. His observations were normal, he was ambulant his wife was happy to take him home.

But of course Joe comes home with lots of questions, which I now struggle to answer without making phone calls to track down the busy medical team. The problem is articulated by several ‘stakeholders’ members of the ‘multidisciplinary team’ on the ward none of whom feel they own the problem of telling this man what he needs to know. There is only one constant in this story- Joe. If Joe can collect the information we need during the course of his hospital stay we might begin to improve the outcome:

In addition to increasing the burden on GPs, it engenders a need for a subsequent GP appointment; it limits GP capacity to respond to patient concerns and queries, at least on one occasion; it may result in a re-referral to the specialist; and it increases GP dissatisfaction with the care provided to the patient by the hospital. BMJ

The problem is Joe often does not know what he needs to know by the end of his hospital stay. It isn’t impossible to work out how to trigger questions for Joe to ask throughout his hospitalisation. What is far more difficult is to motivate every hospital ward and every discipline in a team to address this challenge consistently. It is ‘easier’ to nudge one individual than enlist the cooperation of the dozens of health professionals who will come into contact with Joe. Making people active in healthcare processes has achieved results before:

Influence at Work, a training and consultancy company that Cialdini founded, worked with the United Kingdom’s National Health Service (NHS) in a set of studies aimed at reducing the number of patients who fail to show up for medical appointments. They did this by simply making patients more involved in the appointment-making process, such as asking the patient to write down the details of the appointment themselves rather than simply receiving an appointment card. Sleek

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General practice can evolve- it just has!

 

It’s Thursday night- I don’t blog on a Thursday night. But this isn’t any ordinary Thursday. Today I believe I walked in on the future of general practice in bricks and mortar– designed and run by a couple whose combined age is not much more than mine. I’m not quite sure what I was expecting when I made the appointment to visit. I suspect I was just being nosy- could a practice really do business without a big reception counter? I was prepared to be disappointed. To see the waiting room damaged and tired after more than a year in business. To see little more in the way of big ideas than the loss of that big ugly barrier. What I wasn’t expecting was to meet a couple whose energy and passion for general practice could easily power a small city and to leave feeling overawed by what they have created.

I saw attention to detail in everything that makes for an extraordinary patient experience. From the music in the waiting room, sounds that could be controlled from smartphones with a different selection possible in each room. Removal of the desk in the consulting room, replaced by a tablet computer fully loaded with the latest clinical software. It is a place I want to be- as a doctor, as a patient, as a visitor or in any capacity they will have me. I can’t begin to describe the impact of each room with windows designed to maximise the natural light even deep in the heart of the building, the removal of clutter (no posters anywhere), the exquisite choice of everything on display with an emphasis on less rather than more. Even the treatment room stocked in a way that makes a Toyota factory the most efficient place on earth.

I heard patients being welcomed, smiling faces everywhere, staff who said they were never happier at work. Doctors who clearly enjoyed what they were doing and a sense of purposeful calm in all that was being done.

This is what can be achieved without relying on any external agent even in a so-called area of need. It has been created by people who care enough to work very hard and want nothing less than they expect for themselves. People who want to create an experience that makes it more likely that people will value what’s on offer. Today I believe I was given a rare glimpse into what it will be like in medicine when these ideas are universally adopted because nothing less than the feelings that this place engenders is good enough.

Picture by AmadeoDM

Create your own working conditions or deal with the headaches

It was Friday morning. S/he looked well so I was surprised when s/he said:

I woke up with a headache this morning. I’ve taken paracetamol. I feel a bit better but I couldn’t go to work this morning.

What do you do for a living? I asked. Insert into his /her response:

Teacher/nurse/social worker/call centre operator/forklift driver

Is it busy just now? I asked. Wondering how his/ her boss would take the news of this absence. The smile slipped.

It’s been terrible this year. Lots of demanding (patients/ clients/ kids/shifts).

Then- tears.

I’ve got to hold it together. I’m only six months away from ( holiday/ long service leave/ wedding/ boss leaving)

Is this sustainable? Really?

How much time do you spend on things that are either distractions (not-urgent or important) or someone else’s emergency (urgent /not important)? How much time do you spend on the most valuable quadrant not urgent and important? Why are you always fire fighting (urgent and important) ? Icon made by Ocha from www.flaticon.com

What are you doing during the most productive time of the day? What do you focus on first in the morning? When you are fresh and rested? What are you leaving till later when you should be heading home? Icon made by Freepik from www.flaticon.com

 

It’s your responsibility to set limits to your accessibility. If your boss wants you to do this then s/he doesn’t expect you to do the other.  Are you sure you clarified the situation? YOU have created these unreasonable expectations because the word ‘no’ isn’t in your vocabulary. Icon made by Freepik from www.flaticon.com

 

Finally how much energy, stamina, good will or creativity is left in the tank? There is a limit- even for you. Icon made by Freepik from www.flaticon.com

You are not exempt even if you are a doctor. If you don’t create the life you want then one will be created for you. And it might just give you a headache. You have some thinking to do while you nurse that headache.

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There are no prizes for caring for people the day after you graduate

Hoards of young people in gowns and mortar boards are everywhere in the city this month. For some it will be a very special occasion as they step up to collect prizes bestowed in the name of some worthy luminary. For a few it will be a bumper crop with multiple awards. Others will have to content themselves in the knowledge that he or she who simply passes the final exams is still called ‘doctor’.

Some medical students will also recite the Hippocratic oath. Of which my favourite version appears below:

I swear to fulfill, to the best of my ability and judgment, this covenant:…

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.

Living by this oath does not earn the annual Hippocratic Award for Excellence. If only all graduates could hear Simon Sinek deliver a commencement speech. This is what they might hear. Prize winners might reflect on what it will feel like to inhabit a world where being excellent at your job doesn’t mean you get to wear a gown and hear applause. If you have the good fortune to call yourself doctor then innovation in healthcare is detailed in the oath and begins with yourself.

Picture by klbradt