Medical engagement: A journey not an event

Posted:10 July 2014
Comments 10 comments

Authors

Publication details

ISBN: 978 1 909029 34 7
Pages: 47

What is good medical engagement? In those organisations where it exists, how has good medical engagement been created and sustained? These questions are at the heart of this report, which builds on earlier work from The King’s Fund on medical leadership.

This report is based on case studies of four NHS trusts with acknowledged high levels of medical engagement. It aims to help other organisations that are seeking to create cultures in which doctors want to engage more in the management, leadership and improvement of services. Based on interviews with a range of executives, senior and junior doctors, the report presents key features of each of the four trusts. Its final analytical section highlights common themes and includes a checklist to allow organisations and individuals to assess how far medical engagement is being sought and developed.

Key findings

Medical engagement needs to be part of an overall organisational approach, from board to ward, and needs time to evolve. It is a journey that requires doctors to be motivated and to assume greater engagement with and responsibility for improving the quality of patient care in partnership with clinical and non-clinical colleagues and with input from patients.
The four trusts studied have all enjoyed long-term stable leadership, creating a firm foundation for cultural change. Senior leaders have shown total commitment to medical engagement and leadership.
All four trusts have clear strategies based on quality running throughout the organisations. The distinguishing feature is that these strategies form a way of working for the organisation – they are not isolated programmes.
Each trust has embraced a strong medical leadership structure with doctors in leadership roles at divisional and departmental levels, supported by managers. Despite making great progress, none claims to have a completely embedded medical engagement culture.
Each trust puts considerable effort and resources into selecting senior staff including consultants, and none takes the stance that clinical expertise is sufficient.
Well-developed appraisal and revalidation processes exist in all four trusts. Talent management and leadership development are taken seriously, through education and training, and learning from other organisations.

Policy into practice implications

Medical engagement should be an integral part of the culture of all health care organisations and should be a priority for NHS boards and leaders.
It requires investment in development and training and also in governance arrangements to support the culture.

Comments

Everyone talks about medical or clinical engagement but in reality very few Trusts actually do it well. I was appointed as the MD of Wrightington, Wigan and Liegh FT (WWLFT) in 2010. It was a well performing Trust and had excellent CEO and good Trust Board members. But I received few emails from some consultants asking me 'Why you are coming to WWLFT because we don't feel valued or involved and engaged. So I started my journey of medical engagement. I met 157 consultants individually to get to know them and for them to get to know me. They told me everything I needed to know. Good doctors, good leaders, poor leaders, doctors with attitude and behaviour problems, consultants who are bullies and even some of their consultant colleagues are scared to call at night! I was shocked by what I had heard but NCAS experience had taught me how to deal with anyone.

Four years on by defining WWLFT values, appointed value based leaders, good governance, and good staff and patient engagement we have now transformed the Trust. We are not perfect and still long way to go. But each year 450 less patients dies, all 22 quality measurements have improved and 22 DMDs and CDs are helping me to transform the Trust and to make it one of the best Trusts in the country and we got 15 Awards. Success is not due to one or two individuals but it is when everyone works together as a good team that the Trust can be successful and patients and staff will be happy.

So medical engagement is the key, consultants are intelligent and have many excellent leadership qualities and skills and we got to nurture them and help, support and work with them so that they provide the best care to their patients. Of course we are not perfect and still long way to go but our culture, leadership and effective staff engagement gives me hopes for the future. It is all about values, behaviours, culture and leadership from the Board to ward level which will make NHS successful or failure.

An excellent and well considered report which has real practical benefits in the checklist section. I have started to discuss with my CEO and plan a workshop to see how many of the boxes we tick and what we need to do to improve engagement…especially in 'hard to reach' departments.

Thank you for taking the time to leave this comment . I look forward to visiting WWLFT and seeing first hand your journey to Medical Engagement . As we said in the report there will be many Trusts which are worth looking at and we look forward to discovering other Trusts with high levels of Medical Engagement .

Hard to reach departments or the challenges of Medical engagement is an area which we are keen to explore & offer support should this be helpful. Glad to know the checklist is helpful , thank you for leaving feedback .

I'm intrigued to hear which departments are the hard to reach ones? Are they the same ones across the board? This is a great report and it highlights the importance of engagement. The way to change culture is by changing the conversation but that implies we have a conversation in the first place. That is clearly what Umesh started with.

Thank you for your feedback on this report. Looking at specifics and trends re 'hard to reach' is a piece of work that individual organisations would find helpful.
Communication especially seeking to understand is the first way in and getting Drs to examine their own departmental data .

A most useful report that demonstrates how well these 4 trusts have done and what sustained and consistent policies can achieve. The culture remains the key and engaging the medical workforce is paramount. This is not universal and there is much to be done. Your report points us in right direction.

Musheer,
Thank you for taking the time to look at the report and leave a comment.John Clark and I believe that there are many organisations at various stages of engaging with Medical colleagues and hope these case studies make a helpful contribution .

I got excited when I saw the title of this report, as I assumed that GPs as the most prevalence type of medic would also be discussed.

Maybe this will be in a follow up report? We can learn lots from this report, but the structures and levers are so different. There are loads of us working hard on medical engagement in Primary Care.