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CURRENT CHALLENGES FACING MEDICINE AND MANAGEMENT

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Hospital activity per available bed 26% lower than England. 43% more admin staff than in England ... Culture eats strategy for breakfast. The Patient Perspective ... – PowerPoint PPT presentation

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Title: CURRENT CHALLENGES FACING MEDICINE AND MANAGEMENT


1
CURRENT CHALLENGES FACING MEDICINE AND
MANAGEMENT 29th May 2007 Dr. Tom Frawley
2
  • May you live in interesting times
  • - A Chinese curse

3
Uncertain times a context
  • Bristol Royal Infirmary
  • Dr Harold Shipman
  • Beverley Allitt
  • Dr Michael Neary
  • Sperrin Lakeland
  • Organ Retention
  • Endoscopes
  • Mammography United Hospitals

4
Choice…
  • How to behave
  • Survival
  • Adaptation
  • Skills
  • Learning

5
The Patient-Doctor Contract
  • In the past
  • They give their time, training and expertise and
    expect in return to get autonomy, deference,
    respect and job security
  • …To give and get…

6
The Patient-Doctor Contract
  • Now, however
  • Greater accountability, more assertive and
    better informed patients, a need to collaborate
    with other professions, and constant evaluations,
    inspection, audit and even regular reviews of
    their competence to practice

7
Clinical Interventions
  • Maintain Life
  • Restore Health
  • Prevent harm
  • Reduce Risk
  • Enhance safety
  • The Reality - harmful consequences are more
    common than we recognise
  • 10 in-patient admission adverse event
  • 5 population report adverse effect of medical
    care
  • 18 of patients report being victim of medication
    error in previous 2 years
  • Manage expectations

8
Medicine A Challenging World Sir Brian Jarman
  • 240,000 out of 610,000 deaths some 40 - occur
    in hospital
  • 12 - some 28,000 of these hospital deaths
    caused by avoidable adverse events
  • Large (4x) variation in death rates between
    hospitals
  • Best 400 fewer than average
  • Worst 200 more than average
  • Where is Northern Ireland/Irish Health Service?
  • Where is your hospital
  • Where is your specialty

9
England Wales Health Service Performance
  • People gain access to services more quickly NHS
    Direct and walk-in Centres
  • People waiting more than six months for admission
    as In-patient - down by 85
  • Drop in number of people waiting more than 13
    weeks for an appointment as an Out-patient down
    by 92

10
England Wales Health Service Performance
  • Improvements in outcomes of care and treatment
    for people with coronary heart disease or cancer
  • Mortality rates for cancer have gradually
    decreased
  • More than 50 of people who have a heart attack
    receive clot busting drugs within an hour 84
    receive them within 30 minutes

11
Healthcare Commission Survey of NHS Patients in
England (May 07)
  • 93 said room or ward clean or very clean
  • 84 said they waited 6 months or less for planned
    admissions
  • 20 of patients who needed help eating said they
    did not get enough
  • In 30 Trusts 20 rated the food as poor in
    most other trusts few rated the food as poor
  • In planned admissions, not to critical care
    units, 11 said they shared a room or bay with a
    patient of the opposite sex
  • How would the Republic of Ireland perform?

12
N.I. Health Service Performance
  • Hospital activity per member of staff 19 lower
    than UK
  • Hospital activity per available bed 26 lower
    than England
  • 43 more admin staff than in England
  • Average unit prescribing costs 30 higher in NI
  • Significant variations in unit Trust costs in NI
  • Major variations up to 25 in allocated to
    communities in NI
  • Considerable unused capacity, for example, in
    operating theatres
  • R.O.I. Health Service Performance?

13
  • Need for greater scrutiny, medicine used to be
    simple, ineffective and relatively safe. It is
    now complex, effective and potentially dangerous.
  • The mystical authority used to be essential to
    practice. Now we need to be open and work in
    partnership with our colleagues in health care
    and with our patients
  • Cyril Chandler,
  • Dean of Kings College Medical School

14
LEADERSHIP AND MANAGEMENT
15
Shift Happens!
  • GREATER SUCCESS
  • at GREATER SPEED
  • with CONSTANT UNCERTAINTY
  • with LESS RESOURCE
  • with MORE COMPETITION
  • Our world of work
  • Who wants to play?

16
Unprecedented Change
17
Positive Drivers of Change
  • Changing Public Expectations
  • Patient Knowledge (Internet and Media)
  • New and improved technology
  • Patient Choice
  • Additional Funding

18
Public criticisms
  • Public criticism of clinical professionals
  • Tolerance of poor practice
  • Secrecy about professionals performance
  • Poor communication
  • Paternalism
  • Insufficient accountability
  • Regulation not sufficiently open and transparent

19
What the NEW PATIENT expects
  • Accessibility
  • Knowledge generalist and specialist
  • Skill holistic approach
  • Empathy
  • Care
  • Effectiveness
  • Leadership

20
What the NEW PATIENT deserves
  • To be treated as a partner
  • Not to be seen as compliant and submissive
  • To be given the information required for truly
    informed consent
  • Thoracic surgery example.

21
The Patient Perspective
  • Patients a sense of
  • Powerlessness
  • Frustration
  • Fear
  • Culture eats strategy for breakfast

22
  • The experience is the outcome Hardwire patient
    experience
  • Hitting the targets Missing the point
  • Archie Cochrane Rocking the patient
  • Listen Spend time Hold hand

23
Neither a brave man nor a wise man lay down on
the tracks of history to wait for the train of
the future to run over him. Dwight D
Eisenhower
24
Is everyone a Leader?
  • Those who make things happen
  • Those who think they make things happen
  • Those who watch things happen
  • Those who wondered what happened
  • Those who didnt know anything happened

25
Leadership Competencies
  • Strategic awareness
  • Customer orientation
  • Quality creativity
  • Ethics
  • Individual accountability
  • Team playing
  • Communication skills

26
Leadership
  • Is difficult to define - virtually impossible to
    measure objectively and cannot be taught in
    schools
  • However, the quality of leadership is the most
    important ingredient in the recipe for the
    success of an organisation
  • It is the ability to inspire other people to work
    together as a team, following your lead, in order
    to attain a common objective

27
Leadership
  • No one can do it all alone others must want to
    follow the leader
  • Leadership is learned - the ability to lead and
    inspire others is far more instinctual than
    premeditated and is acquired through the
    experience of everyday life

28
Leaders v. Managers
  • The manager administers
  • The leader innovates
  • The manager has a short-range view
  • The leader has a long-range perspective
  • The manager asks how and when
  • The leader asks what and why

29
Leaders v. Managers
  • The manager has his eye on the bottom line
  • The leader has his eye on the horizon
  • The manager accepts the status-quo
  • The leader challenges it.
  • Warren Bennis

30
The Essential Tasks of Leadership
  • Tune into the environment, see need,
    opportunities Encourage curiosity that opens our
    eyes to new possibilities not just about problems
  • Be dissatisfied, generates fresh thinking.
    Creativity, find new approaches, dig beyond where
    we are, identify new possibilities, approaches

31
The Essential Tasks of Leadership
  • Anticipate a vision that will mobilise people to
    act. Change begins with hope. Get other people to
    see it too. To pilot is important dream. Small
    steps important.
  • Coalition building, cross boundaries water
    walkers need stones

32
The Essential Tasks of Leadership
  • Find, recruit, identify the team that will make
    it happen. A dream needs to brood.
  • Persevere until you wear down the middles have
    passion. You can run out of time and money.
  • Forecasting is difficult if you are doing
    something unique.
  • Run into obstacles. People get tired, that is
    when critics emerge.
  • Separate lines.

33
Leadership is Key
  • Leaders must ignite
  • Passion
  • Pace
  • Drive
  • Leaders must Build Common Purpose

34
Drivers for Todays Workforce
  • Emotional being involved in ones work
  • Cognitive focussing hard while at work
  • Physical being willing to go the extra mile
  • Engaged Staff Feel positive about job Perform
    better

35
The Essential Tasks of Leadership
  • Make heroes of everyone, appreciate, recognise
    and acknowledge everyone. Say thank you. No one
    wants leaders, they rise also to the challenge.
    Energy
  • Communicate, communicate, communicate…

36
Staff -
  • Follow Leaders because they want to
  • Human beings powered by emotion
  • Ambiguous Leadership

37
Managing Informal System
  • Dolly the Leader
  • Nurses in charge of mood of patients
  • Cultural Blackspots dominated by harassment
    and bullying

38
  • AN EFFECTIVE COMPLAINTS SYSTEM

39
  • Complaints
  • Real time insight.

40
Building an Effective System
  • Focus on rights of Patients
  • Right to safe treatment
  • Importance of good record keeping
  • Importance of good communication - Between
    Clinical staff - Between Clinical staff and
    patients/ families

41
Acknowledging Mistakes…
  • Openness is a precondition for learning
  • Complaints, changes and mistakes are logged and
    replayed
  • Mistakes are acknowledged, even celebrated as a
    source of information
  • Everyone does better in future
  • A learning organisation develops

42
In Summary
  • A whole system
  • Strong compliance to a uniform system
  • Rooted in local resolution
  • Independent 2nd level other than body
    complained of
  • Ombudsman final recourse

43
An Effective Complaints System
  • Easy to access
  • Fair
  • Flexible
  • Ensure confidentiality
  • Clear and
  • Timely
  • Integrated with other systems to provide
  • Valuable Feedback and
  • Engender trust from service users and staff

44
10 Tips for Dealing with Complaints
  • Keep it simple
  • Use the phone more dont automatically write
  • Find out what the complainant wants you to do
  • A quick apology can be better than a long letter
  • Give personal and specific replies

45
10 Tips for Dealing with Complaints
  • Follow the mother principle
  • Dont pass the buck
  • Be clear what solutions you can offer
  • Let people know about improvements you make as a
    result of complaints
  • More complaints can be good news! It shows your
    customers trust you to take them seriously

46
The Rights Responsibilities of Complainants
Key elements of an effective complaints system…
47
The Core Values That Inform Our Work
  • Independence
  • Integrity
  • Impartiality
  • To give life to these core values we treat people
    with courtesy, consideration and honesty And
    respect their privacy

48
Benefits of effective complaints system
  • Identifying areas for improvement
  • Creating a second chance to provide the service
    and satisfaction to dissatisfied clients
  • Leading to….
  • Strengthening public support for the system of
    public service delivery

49
Designing Effective Complaints Systems
  • Go the extra mile
  • Make the service personal
  • Deliver on promises for the system
  • Deal with complaints as well as we possibly can

50
Why we need complaints systems…
  • Working in the PUBLIC service means…
  • Accountability
  • Especially to those who are dissatisfied
  • People have a RIGHT to complain
  • Responsibility
  • People do not have a choice
  • Guard against insensitivity

51
Why we need complaints systems…
  • BUT it doesnt mean…
  • We are immune to changes in society
  • People may not have choice, but they do have
    expectations
  • Expectations are changing

52
Why we need complaints systems…
  • Change in Public Expectations…
  • Accessibility and choice
  • Responsiveness
  • Effectiveness and safety
  • Openness
  • Transparency
  • Increasingly comparing public sector service with
    private sector service

53
Why we need complaints systems…
  • Change in Government Policy…
  • Readiness to adopt radical solutions to issues of
    service delivery
  • Public Sector may be guaranteed first crack at
    solving problems, but what if fail?
  • Increasingly looking to private sector for
    solutions to public service delivery

54
Why we need complaints systems…
  • Old borderlines are evaporating, old categories
    are merging. The divisions between commercial,
    public-sector and non-profit organisations are
    becoming blurred. All organisations now act on
    the same stage, and need to justify their place
    on that stage.
  • The Big Idea Robert Jones

55
Why we need complaints systems…
  • So… why do we need complaints systems?
  • Because we are obliged to be accountable
  • Because society is changing
  • Because Government policy is changing
  • BECAUSE WE NEED TO UP OUR GAME

56
Accountability
  • Accountability must be provided to citizens and
    users of public services, especially those who
    are dissatisfied
  • Citizens and users have a right to complain
  • Accountability- a complex and multifaceted
    concept
  • More than discharging responsibility

57
Accountability
  • If actions to obey instructions- to be
    accountable requires only the report that these
    instructions have been obeyed
  • If actions require the exercise of discretion (to
    make choices, take decisions)- to be accountable
    also requires an explanation

58
Accountability
  • Public officials are accountable for
  • the results or outcomes of their actions
  • the professional standards of their work
  • the effective use of resources, including
    financial resources
  • If users of system feel service has fallen short
    of expectations- system needed to address
    deficiencies
  • Complaints system

59
The Importance of Ethics
  • Ethics must inform all of the fundamental values
    that determine our professional and personal
    behaviour
  • Ethics is concerned with
  • honesty
  • fairness
  • justice
  • respect for others
  • making us think about the impact of our behaviour
    on others and, by extension, our reputation

60
The Importance of Ethics
  • Shouldnt see ethics as a ring-fenced boundary
  • Not a set of mechanical, abstract rules to be
    wheeled out and applied to some abstract
    circumstance
  • For our discussion is about no ordinary matter,
    but on the right way to conduct our lives
  • Plato

61
The Importance of Reputation
  • Reputation is a precious commodity
  • Takes a lifetime to build, can be destroyed in a
    moment
  • Once reputation is lost, it can be incredibly
    difficult to rebuild, if not impossible

62
Key issue - risk to reputation
  • Common theme from case studies where reputation
    is lost denial (Randall 2007)
  • Typical chain of events leading to reputational
    catastrophes (Wharton School, University of
    Pennsylvania)
  • Theres an initial mistake, often minor, that
    goes uncorrected
  • A subsequent error compounds the initial error

63
  • Attempts to correct the problem are often
    half-hearted, either because there is no
    recognition of the increasing seriousness of the
    situation, or executives are in denial
  • When the problem eventually becomes too big to
    ignore, attempts are made to hide the truth and
  • There is an awful moment of acceptance that the
    situation is completely out of control

64
Words to live by…
65
  • I Have Seen the Enemy
  • And He Is Us

66
  • A belief that what we are doing is important
  • An empathy for the people we work with and work
    for
  • The certainty is change
  • A sense of humour

67
  • When You Point Your Finger At Someone There Are
    Three Fingers Pointing At You

68
  • Things Do Not Change
  • We Change
  • Henry David Thoreau

69
Final Thoughts!
  • Nothing in life is certain
  • The public is often (very) demanding
  • Those with the least to complain about often
    complain the most and those with the most to
    complain about often complain the least
  • Simple courtesies can make a big difference and
    the word sorry can transform the circumstance

70
It should be borne in mind that there is nothing
more difficult to arrange, more doubtful of
success, and more dangerous to carry through than
initiating changes in a States
arrangements. The innovator makes enemies of
all those who prospered under the old order, and
only lukewarm support is forthcoming from those
who would prosper under the new Machiavelli
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