Participants (who we gave one job title: ‘excellence accelerators’) immersed themselves in discussions, which included the possibility that their work patterns would need to be extended to 24/7 cover and that their roles as they currently know them may not be needed. They examined and looked for better ways of establishing the sometimes ‘wicked’ issues involved in gaining commitment from consultant colleagues on a consistent approach to job planning (how you allocate doctors’ sessions for different elements of the role), and they demonstrated capability and capacity to lead ‘learning cultures’.
Just five days later I woke up to numerous Twitter messages about Jeremy Hunt’s launch of his 25-year vision for the NHS, which struck a slightly less positive chord.
Political leaders are keen to make good on their promises and offer benefits to the public and patients; sometimes the challenge they face is how to engage clinicians. Whatever you think about the way the issue of seven-day care has been handled, the challenge faced by the Secretary of State is not dissimilar to the one facing NHS leaders all over the country – how to get the workforce, particularly clinicians, working in new ways more closely aligned to the changing nature of care.
My observation is that whether trying to introduce seven-day services or job planning within a trust, adequate preparation, conversation and understanding are crucial. Our work has shown that the introduction of revalidation was much more successful in organisations where engagement was encouraged rather than enforced. The desired outcomes were also more likely to be achieved when clinicians felt that the principle sat comfortably with their values and professional conduct. Establishing this compact, sometimes referred to as 'gives' and 'gets’, sits at the heart of the culture from the often quoted North American exemplars in quality and safety and patient care, including Virginia Mason, The Mayo Clinic, Kaiser Permanente and Intermountain Healthcare.
In our UK-based work on examining the ingredients of a climate in which medical engagement thrives, we have established that it is those organisations that invest in and focus on nurturing cultures in which mutual respect for clinical and non-clinical opinions is sought and achieved, where commitment is prized over compliance.
At the start of what Jeremy Hunt said would be his longest and most important speech to date on the NHS, he suggested a departure from demoralising and dehumanising targets and a shift towards becoming more human: designing a world where people come first, the title of Steve Hilton’s book. In his book Steve Hilton writes, ‘Empathy is not a word you hear very much in government. But to understand a problem and imagine a solution requires an understanding of the people affected.’ This applies equally to patients and NHS staff. There is a need to acknowledge the agility, ability and excellence that resides in all those who committed much of their working lives in the service of the NHS, including our #ExcellenceAccelerators. Bright sparks are capable of helping to illuminate and problem solve but if they are not utilised or included can, like an untended flame, burn the house down
In the discussions preceding the Secretary of State’s speech, the comment by John Appleby, our Chief Economist, that NHS finance directors have said that morale is at an all-time low had been much quoted. Following the speech the establishment of the Twitter handle #ImInWorkJeremy, a campaign started by a junior doctor to highlight the more nuanced arguments involved in providing seven-day working, reinforced the need to pay attention to morale. The campaign now has thousands of clinicians and patients contributing tweets of appreciation for teams who provide ‘out-of-hours care’ and highlighting the move towards seven-day services happening in many, though not all, hospitals. Jeremy Hunt may well have been targeting his speech at the corridors of the BMA or those unwilling to consider different ways of delivering care, but unfortunately it has been perceived as criticism and a lack of understanding by a wider group of doctors, many of whom are open to change and are the ‘bright sparks’ on whom we will rely to deliver improvement and transformation in care.
Looking back at the visual minutes, which captured some of the content of the medical leadership development day, ‘Unlocking quality care for all’ leaps out alongside the question ‘How are you going to get people engaged in better value?’; attending to both will require our political, policy and system leaders at all levels to be more human and harness the considerable talent of our #Excellence Accelerators.
Views from the day
- Find out more about our medical leadership work
- Read our reports: Medical engagement: a journey not an event and Medical revalidation: from compliance to commitment
- Watch Jeremy Hunt set out his 25-year vision for the NHS