Talking leadership: clinicians leading transformational change

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Ahead of our latest report and eighth annual leadership and management summit – both on the subject of transforming health and care – Taj Hassan, Consultant in Emergency Medicine at Leeds Teaching Hospitals NHS Trust, and President, Royal College of Emergency Medicine, answers our questions about how clinicians are contributing to transformational change in the NHS.

Tell us about your current roles in health care

Life as they say is busy! I continue to practise actively, doing my share of late shifts and night shifts in two busy inner city emergency departments (EDs), as well as tackling all the challenges of leading a Royal College at a time when delivery of emergency care is going through the stormiest of times. We are facing incredible pressures in EDs with performance against the four-hour waiting time standard (time from a patient arriving in ED to being discharged, admitted or transferred) being the worst since records began. In an increasing number of departments doctors, nurses and managers are struggling to maintain safe delivery of care to patients with acute needs due to high demand and delays in accessing an in-hospital bed.

What are the clinicians you speak to telling you about the challenges they are facing?

The major challenge facing clinicians at that the moment is crowding in the ED. Like any engine, a hospital is hugely reliant on flow through its systems and at present the flow of patients is being significantly compromised. Patients who have been assessed and treated are unable to be moved into a hospital bed in a timely fashion because there are not enough beds available and the flow of patients back into the community is being compromised due to a paucity of social care funding. Added to that is the challenge of increasing demand and patients presenting with more complex needs as our elderly population grows and as access to primary care becomes more difficult. Add in the staffing crisis affecting doctors and nurses and you have a ‘perfect storm’.

Why are clinicians crucial to leading the way in terms of changing the way we deliver services in this country?

The NHS has always in my eyes been the leading health care organisation in the world on a value-for-money basis. Yet our spend on health care continues to lag behind that of some other developed countries. There has never been a more important time for clinicians to be involved in helping to decide how the money that is available can be spent and more importantly to persuade our government that more needs to be done to fund the NHS. Equally importantly, we need to find ways to value our staff so that we can both retain them and make them more productive in the face of the tsunami of work that we face every day. We have transformed our staffing models over the past decade with more consultant-led care and senior sign-off rather than relying on an isolated command-and-control structure. We also need working patterns that are more sustainable and enhanced gatekeeping with better ambulatory emergency care. Examples of changes made include the development of major trauma centres, which have seen services centralised in fewer centres of excellence, saving lives as a result, and clinical decision units (CDUs), which allow patients requiring further assessments and tests to be cared for in an area adjacent to the ED.

What are the enablers for clinician-led change?

Many departments remain understaffed, but where clinical staffing models are approaching the required standard, we have remarkable innovation and high-quality care. This allows a strong values-based team to focus on the key elements of care delivery and also to consider wider reconfiguration of services. To meet the challenges of the 21st century we must invest in senior staff to allow them time to invest in their teams and think, plan, act and recalibrate. In addition to the examples of major trauma centre developments and CDUs, one could add the increasing focus on a multidisciplinary workforce in ED, co-location models and dedicated frailty units. All these changes are helping clinicians to meet present and future needs in a more focused manner.

What are your hopes and aspirations for the future?

Two things are on the horizon and within our grasp if we are disciplined and able to focus on delivery; the third is a hope. In 2017, the specialty celebrated its 50th anniversary and launched a workforce strategy, which, if implemented well over the next four to eight years, will more than double the number of emergency physicians in this country. That will drive standards much higher and make our departments much safer. Second, there is now a clear realisation that solutions to the problem of the crowded unsafe environment of an ED need to involve the wider system in a much more integrated multidisciplinary fashion. There are ‘exemplars of excellence’ with major trauma centres well established, greater focus on dedicated care delivery models for elderly patients and better ambulatory care models. What is required now is a clear political will to fund our NHS in its 70th year, allied to the transformational changes needed, so that it can meet these challenges and truly be a world-class organisation for its people.

Comments

Jaweeda Idoo

Position
Clinical Director Transformation,
Organisation
Stockport Neighbourhood Care
Comment date
02 April 2018

Great article Taj. I'm a GP who has Clinically led change, pathway redesign and quality improvement both in my GP Practice (Social Prescribing, Alvanley Family Practice) and Stockport Health and Social Care.
I've learnt that you need to work with great NHS mangers and Project Support. That the triumvrant approach that coproduces with Frontline staff and patients, using an evidence base and values has had a profound effect on the services we deliver

Taj Hassan

Position
President,
Organisation
RCEM
Comment date
02 April 2018

Agreed absolutely. The greatest positive change has been the importance of multidisciplinary working. Great teams truly achieve to excess. Yet we continue to do it in an environment where we do not value our teams as much as we should for the Herculean work they do !

Millicent Taniform

Position
Pre-qualifing Nurse,
Organisation
Bucks New University
Comment date
13 November 2018

This is a great article. it summaries most of what I have been researching on about Leadership in Healthcare and Multidisciplinary collaboration. As I aspire to become a successful Nurse leader and deliver care that is centred on patients needs and safety, this article has created an awareness of what clinicians are faced with daily and how they constantly strive to improve outcomes,

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