A roadmap for medical engagement

The importance of medical engagement in creating organisational cultures that deliver high-quality, safe and effective health care is well known. Reports from Robert Francis QC, Bruce Keogh and Don Berwick have all reinforced this, citing a lack of medical engagement at many troubled trusts. But what does good medical engagement look like in practice?

Highlighting what works

A recent report from The King's Fund seeks to describe good medical engagement, looking at how organisations have created and sustained it. Medical engagement: a journey not an event is based on case studies of four trusts with acknowledged high levels of medical engagement:

  • Northumbria Healthcare NHS Foundation Trust
  • Salford Royal NHS Foundation Trust
  • Southern Health NHS Foundation Trust
  • University College London Hospitals NHS Foundation Trust.

'The report is based on interviews with a range of executives and senior and junior doctors at these trusts,' explains Vijaya Nath, Assistant Director of Leadership Development at The King's Fund. 'It presents key features of each trust, highlights common themes and includes a checklist to help organisations and individuals to assess their own levels of medical engagement.'

A journey not an event

The trusts share a number of features that have helped them  to establish high levels of medical engagement, including:

  • clear, long-term strategies that embed quality in the culture of the organisation 
  • stable leadership – in three of the four trusts, the chief executive has been in post for more than ten years
  • governance structures that, although varied, support medical engagement and are backed up with a mutual respect between medical and other leaders at all levels
  • a focus on leadership development and education and training, which is linked to a robust approach to appraisal and revalidation
  • ensuring that doctors recruited as consultants and medical leaders have values that match those of the trust, alongside excellent clinical skills.

However, there is more to do. 'What's striking across all four case studies is that each would say that, in terms of medical engagement, they are not there yet,' explains Vijaya. 'They are now looking at what else they can do. For example, can more be done to develop the talent pipeline? Some trusts are encouraging junior doctors to take part in service improvement initiatives and providing opportunities for leadership development which, in turn, may encourage junior doctors to return to the trust as consultants.'

'Diversity is another area that needs focus in the future,' argues Vijaya. 'Compared with a decade ago, there are more women coming through medical school now and that might mean adjusting how we engage with medical leaders in the future, reviewing the perceived and real-time commitment that it involves. But it's broader than that; trusts need to challenge themselves to draw medical leaders from a more diverse pool, mirroring our patient populations and welcoming those who might challenge how things are done.'

One piece of the puzzle

It's clear from the report that medical engagement has to be planned, resourced and part of a wider strategic commitment to high-quality care. 'Medical engagement is a core component of an overall organisational commitment – from the board to the ward – around quality, safety, service improvement and engagement. At the case study trusts, the approach to quality and engagement is not a specific programme but a "way of doing things around here" that is part of the culture and pervades everything the trusts do.'

'With this in mind, I would advise those seeking to gauge medical engagement in their own organisations to start by honestly assessing the culture that exists,' says Vijaya. 'For example, what's it like in terms of reporting incidents and how are these used to change practice and processes? What focus is there on continuous quality improvement and how are doctors involved in this? Use the checklist in our medical engagement report to help and listen to the advice from medical leaders in video interviews on our website.'

Extending engagement beyond doctors is equally important, argues Vijaya: 'The key to developing caring and effective cultures is to get everyone to take responsibility for the organisation as a whole – not just for their role or work area. We call this a culture of collective leadership. These cultures are characterised by high levels of dialogue that will, in turn, support a shared commitment to improving the quality of care.'

Future challenges 

As financial pressures continue to build, medical engagement will only become more important: ‘In the report, a medical director highlights that doctors and other clinical professionals need to engage with the scale of the financial pressures that are looming and develop even more innovative solutions to deal with these,’ explains Vijaya. ‘We highlight what can be achieved if there is a sustained and collective vision to create an organisational culture where all staff, particularly doctors, are motivated to share in delivering the highest-quality care. The challenge will be to build on that in fiscally tight times.'