Engaging clinicians: keeping the bright sparks burning

We recently held a medical leadership alumni development day. These provide an opportunity for the Fund to catch up with clinicians at all stages – from those at the start of their career to medical directors – who are equally diverse in the way that they think about their work. We took the opportunity to look at what the future NHS might hold on her 100th birthday and reflected on the fact that it's often easier to have a conversation about the NHS in 30 years as opposed to the next two years!

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

Medical leadership development day graphic

Medical leadership development day graphic

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#544346 John Kapp
Social Enterprise Complementary Thaerapy Company SECTCo

Why doesn't anyone recognise that the primary care ship is sinking like tthe Titanic, having hit the iceberg known as Big Pharma? All this waffle is rearranging the deckchairs, rather than identifying an fixing the root cause - which is overprescribing of drugs that doen't even claim to cure the disease for which they are prescribed, but have side effects which make patients keep coming back, clogging the system, and burning out GPs who retire early to save themselves from a premature death. The solution is to empower them to do what their name implies ('doctare is latin for 'teach') and prescribe Mindfulness Based Cognitive Therapy (MBCT) 8 week courses instead of Prozac. See papers on reginaldkapp.org.

#544351 Sam Majumdar
Consultant Surgeon; QI lead
NHS Tayside

Leadership & Culture are the heart and lungs of any successful organisation. They are inherently interdependent too. A culture that begets success must be a positive, empowering & empathic one. Leadership for success must come from within the heart of the organisation for it to adapt, evolve & thrive into the future at the face of all uncertainties.
I would like to politely remind those, who remain unaware of some simple facts: our NHS, in her 6+ decades of life, has shown her resolve, resilience and forbearance at the face of many odds and numerous crises and survived.
As a hospital doctor, as far back as I can remember, we have always provided 24 hours x 365 days service. Mothers don't give births on Mondays to Fridays. People don't become acutely ill, have MI, CVA, RTA etc. just on week days only. Vast numbers of NHS staff are working round the clock, day in day out, providing that much needed care.
One must not underestimate the inherent ability of our NHS to grow and prosper into the future.
An organisation that doesn't evolve with the pace of time is surely destined for sad demise and disintegration. We are all acutely aware of such unwanted consequences.
To allow our, much needed & much beloved, NHS to thrive now and beyond 2048; we must protect her from all toxic outside infringements.
We want to see our NHS led by clinicians who are passionately embedded in their jobs and 100 % engaged & involved in strategic decision making for the organisation.
NHS will not just be alive in 2048; she will thrive too!
Yes we can make it happen.

#544352 Vijaya Nath
The King's Fund

Sam it's great to have an Excellence Accelerator who attended and contributed to the day comment . I know how much you are committed to working in a thriving NHS and how much you live & breath collaboration . We will continue to support all your successes ( and those of all the clinical & non clinical leaders whose paths we cross ) as an important priority .The Fund's is as commitment to the NHS as it was at her inception and it will continue to do so beyond her 100th birthday .

#544354 Sam Majumdar
Consultant Surgeon; QI lead

We are eternally grateful for the continuous work and support from the King's Fund. Our NHS needs all these and leaders like you & your fantastic team to be with us through out this journey to support humanity; now and forever.
A big thank you from myself & all of our NHS Staff

#544356 Róisín McKeon-Carter
Clinical Director Neonatal Services / Advanced Nurse Practitioner
Plymouth Hospitals NHS Trust

Clinician engagement must start at the root, that is, in universities offering courses in medicine, nursing, midwifery and all AHP, the 'bright sparks' are starting their NHS journey there! They will ensure the survival / longevity of our NHS & become our future clinical leaders.

Currently, the 'burden' of clinical leadership is often handed to individuals (usually consultant doctors) many of whom do not have the 'tools in the toolbox' to lead a MDT including managers, accountants etc as their training & education has been clinically focused. Therefore, organisations must support 'bright sparks' / clinical leaders to gain leadership skills either within their own organisation or from the Kings Fund, otherwise there will be a disillusioned, frustrated workforce who will not engage. Those competent skilled clinical leaders who foster an ethos of trust & respect & who engage with the MDT will be offered support from the 'valued' MDT (including many 'bright sparks') & will be offered suggestions / innovations that will lessen the 'burden' for the CD & ensure longevity for their service.

The #iminworkjeremy is powerful as it ignited a passion and demonstrated solidarity among teams working in the NHS. Trainee doctors, nurses, midwives, ancillary staff & AHPs have supported their consultant doctor colleagues posting pictures & espousing how hard they all work. It also highlighted the financial burden for trainee doctors given current university fees compared to other professional groups in the NHS who have supported degrees & achieve a lifestyle (house, car, holidays) sooner than their medical colleagues.

#iminworkjeremy also demonstrated the good humour that is imperative if you work unsocial hours in the NHS, you've GOT TO laugh.....

#544359 Taruna Chauhan
T Chauhan Consultancy Ltd

Having worked in the NHS. Patients are ill 24/7 and a baby can arrive at any time. I strongly believe that it should be shift rota for all staff in the NHS, Not just nurses. Consultant on call should be gradually out phased , on call is expensive and by the time the consultant has finished. I have seen them very tired, and therefore more likely to make an error. The NHS does need people to be open to new ways of working. I agree that this should start in the universities. I have been at both sides so I am speaking from my own experience.

#544360 Abid Hussain
Director of Infection Prevention and Control
Public Health England Birmingham

The most challenging aspect of the NHS at the moment is the morale of the workforce. It stretches across disciplines, grades and geographical areas and is deeply entrenched. Must like turning an oil tanker it is a slow process, but can be "accelerated" by enthusiastic and dynamic leaders. This is change management on a massive scale, and can only begin when there are signs of a widespread culture change. The is a need for engagement, but I feel that real engagement involved timely and appropriate feedback, which evidence of action in real terms. This can be as simple as setting up a managerial "drop in session" all the way through to business cases and different patterns of working. It is work remembering that the resources, knowledge and skills of the NHS is a fantastic resource that will wither if we allow the continuous haemorrhaging of disillusioned staff.

#544375 Stephen webb

Reading the 'visual minutes', it seems like another great event at The King's Fund!

#544377 Jill Stoddart
International Operations Director
Royal College of Physicians

Love the visual notes quote...'excellence is not an act but a habit'. Says it all.

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