Junior doctors are essential for the NHS to achieve efficiency savings and engage in leadership, but they are currently disengaged. Junior doctors experience a clinical-managerial divide, high workload due to reduced hours without decreased responsibilities, lack of organizational allegiance, and low morale. Initiatives to encourage clinical leadership through training, career structures, incentives, and information systems could help address this disengagement.
IN THIS SUMMARY
Many healthcare organizations struggle to communicate effectively with physicians and engage them, particularly when dealing with change implementation. In Inside the Physician Mind, Joseph S. Bujak provides an insider's perspective on how physicians think, outlining beliefs and behaviors specific to physicians and identifying barriers that inhibit productive relationships. Armed with this information, healthcare organizations can improve communication and help physicians and organizational staff members establish the trust necessary for effective change initiatives to take place.
SUBSCRIBE TODAY
http://www.bizsum.com/summaries/inside-physician-mind
The NHS Bermuda Triangle by Marc Baker, Ian Taylor and Daniel T JonesLean Enterprise Academy
We've been applying Lean Thinking in healthcare for the past five years, Over that time we have discovered two things:
First, the good news. Lean works in healthcare. The Bad news: Lean will never take toon in the NHS as it stands: it is management that needs to change.
Occupational Health: a challenge for primary health careHealth and Labour
Presentation by dr. Dame Carol Black, UK National Director for Health and Work at the WHO/TNO/Dutchgovernment Congres 'Connecting Health and Labour' 29 - 1 December 2012
IN THIS SUMMARY
Many healthcare organizations struggle to communicate effectively with physicians and engage them, particularly when dealing with change implementation. In Inside the Physician Mind, Joseph S. Bujak provides an insider's perspective on how physicians think, outlining beliefs and behaviors specific to physicians and identifying barriers that inhibit productive relationships. Armed with this information, healthcare organizations can improve communication and help physicians and organizational staff members establish the trust necessary for effective change initiatives to take place.
SUBSCRIBE TODAY
http://www.bizsum.com/summaries/inside-physician-mind
The NHS Bermuda Triangle by Marc Baker, Ian Taylor and Daniel T JonesLean Enterprise Academy
We've been applying Lean Thinking in healthcare for the past five years, Over that time we have discovered two things:
First, the good news. Lean works in healthcare. The Bad news: Lean will never take toon in the NHS as it stands: it is management that needs to change.
Occupational Health: a challenge for primary health careHealth and Labour
Presentation by dr. Dame Carol Black, UK National Director for Health and Work at the WHO/TNO/Dutchgovernment Congres 'Connecting Health and Labour' 29 - 1 December 2012
New Technologies Are Required To Automate Expanded Physician Workflow. To create a sustainable healthcare system that provides affordable, high-quality healthcare to all, we will have to adopt a population health management (PHM) approach. While the transition to PHM will be difficult for providers and patients alike, the change could be facilitated and accelerated through the use of health information technology, self management tools, and automated reminders that are persistent in changing behaviors.
Personalized Health and Care: IT-enabled Personalized HealthcareIBM HealthCare
Healthcare reform currently focuses on changing the structure and incentives of the U.S. healthcare system. Healthcare transformation requires a more open, robust health information technology (HIT) environment to go beyond removing waste and inefficiencies to discover the science of health and care. Learn how IBM can make this possible.
We’re always ready to take on board the views of the people who matter most: it’s what helps us focus on providing products and services that people really need. This is the tenth year in which we’ve conducted our Health of the Nation study, canvassing the opinions of GPs right across the UK. This year we’ve extended our research to include the views of 1,000 patients to understand their experiences of healthcare in the UK.
Stratified pathways of care...from concept to innovationNHS Improvement
NHS Improvement is working in partnership with patients, clinical teams, the Department of Health (DH) and voluntary organisations to improve the effectiveness and quality of service delivery for those living with and beyond cancer. This is a summary report of this year’s work and includes pathways for breast, colorectal and prostate cancer.
Scaling the PCMH Delivery Model with AutomationPhytel
The patient-centered medical home continues to make progress. Much remains to be learned about the most effective techniques for building and maintaining a PCMH. But three conclusions can already be drawn from the pilots that have already been done:
1) Successful medical homes will have to perform population health management;
2) They will need a variety of health IT tools to do that and to coordinate care effectively; and
3) They will have to gain the cooperation of the other providers in their medical neighborhoods.
Major changes in practice workflow and work roles must accompany the proper use of information technology. In the end, practices must be completely reengineered to provide effective, patient-centered medical homes—and the environment in which they operate must also change to permit seamless care coordination. But all of this change can be less painful and lead to more productive results if practices use the right combination of technologies to scale population health management.
JONAVolume 41, Number 5, pp 204-210Copyright B 2011 WolterMerrileeDelvalle969
JONA
Volume 41, Number 5, pp 204-210
Copyright B 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
T H E J O U R N A L O F N U R S I N G A D M I N I S T R A T I O N
Nurse Manager Leadership Development
Leveraging the Evidence and System-Level Support
Laura Fennimore, DNP, RN
Gail Wolf, PhD, RN, FAAN
The complexities of healthcare demand new leader-
ship approaches to achieve organizational goals while
developing and sustaining healthy work environ-
ments. The nurse manager is the defining role, cru-
cial to achievement of workplace outcomes. Preparing
nurses for this dynamic, complex role is often depen-
dent on didactic education or on-the-job training that
falls short of true leadership development. The authors
describe an innovative approach to the development
of successful nursing leaders across an integrated
healthcare system.
Changing patterns in healthcare, including changes in
patients and providers, medical advances, information
technology, and reimbursement, create enormous
challenges for nursing leaders.1 Managing these
changes and driving strategic execution of goals re-
quire strong leadership that begins with adequate
preparation. However, studies indicate that frontline
managers are often the least prepared to handle these
challenges. Leadership development for nurse man-
agers is often loosely structured and fails to offer
experiences and mentors that assist nurse managers
to develop the competencies of successful leaders.2
Nurse managers are often selected for their positions
based on their clinical expertise, but they lack
confidence in topics ranging from human resource
management, preparing and monitoring budgets,
managing upward to senior colleagues, and using
technology in everyday practice.3-5 Being a successful
leader on the front lines requires not only clinical
expertise, but also the effective use of emotional and
cultural intelligence as well as energy management
skills.6 Chief nursing officers (CNOs) and other
nursing leaders in acute care hospitals describe com-
munication, conflict resolution, role transitioning,
scheduling, budgetary and payroll management, per-
formance evaluation, and staff counseling as the pri-
mary developmental needs for nurse managers.3
Establishment of a high-performing culture is the
critical element that distinguishes units where pa-
tients receive high-quality care from units where pa-
tient care is poor and unacceptable. Nurse managers
are Bchief culture builders[ who lead professionals
rather than just manage workers. They must be
competent in establishing healthy work environ-
ments through development of staff, effective dele-
gation, trust, and mentorship.7-9 Nursing leadership
is linked with the national patient safety agenda
through interventions targeted at preventing pres-
sure ulcers, reducing the incidence of central line
infections, and effective discharge planning to pre-
vent hospital readmissions within 30 days of patient
discharge. The attainment of ...
This monograph provides an assessment of the current hospital-physician landscape and outlines an innovative vehicle for advancing hospital-physician relationships that has the potential to improve care delivery and coordination, clinical quality, and patient cost. Our findings and recommendations address:• Changes in the market place.• The concept of an integrated medical staff model.• The role of operational clinical integration, enabled by an Electronic Medical• Record, toward creating virtual medical staffs.• Benefits to the hospital, physicians, patients and community.• What boards and senior management can do to move toward the model.
New Technologies Are Required To Automate Expanded Physician Workflow. To create a sustainable healthcare system that provides affordable, high-quality healthcare to all, we will have to adopt a population health management (PHM) approach. While the transition to PHM will be difficult for providers and patients alike, the change could be facilitated and accelerated through the use of health information technology, self management tools, and automated reminders that are persistent in changing behaviors.
Personalized Health and Care: IT-enabled Personalized HealthcareIBM HealthCare
Healthcare reform currently focuses on changing the structure and incentives of the U.S. healthcare system. Healthcare transformation requires a more open, robust health information technology (HIT) environment to go beyond removing waste and inefficiencies to discover the science of health and care. Learn how IBM can make this possible.
We’re always ready to take on board the views of the people who matter most: it’s what helps us focus on providing products and services that people really need. This is the tenth year in which we’ve conducted our Health of the Nation study, canvassing the opinions of GPs right across the UK. This year we’ve extended our research to include the views of 1,000 patients to understand their experiences of healthcare in the UK.
Stratified pathways of care...from concept to innovationNHS Improvement
NHS Improvement is working in partnership with patients, clinical teams, the Department of Health (DH) and voluntary organisations to improve the effectiveness and quality of service delivery for those living with and beyond cancer. This is a summary report of this year’s work and includes pathways for breast, colorectal and prostate cancer.
Scaling the PCMH Delivery Model with AutomationPhytel
The patient-centered medical home continues to make progress. Much remains to be learned about the most effective techniques for building and maintaining a PCMH. But three conclusions can already be drawn from the pilots that have already been done:
1) Successful medical homes will have to perform population health management;
2) They will need a variety of health IT tools to do that and to coordinate care effectively; and
3) They will have to gain the cooperation of the other providers in their medical neighborhoods.
Major changes in practice workflow and work roles must accompany the proper use of information technology. In the end, practices must be completely reengineered to provide effective, patient-centered medical homes—and the environment in which they operate must also change to permit seamless care coordination. But all of this change can be less painful and lead to more productive results if practices use the right combination of technologies to scale population health management.
JONAVolume 41, Number 5, pp 204-210Copyright B 2011 WolterMerrileeDelvalle969
JONA
Volume 41, Number 5, pp 204-210
Copyright B 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
T H E J O U R N A L O F N U R S I N G A D M I N I S T R A T I O N
Nurse Manager Leadership Development
Leveraging the Evidence and System-Level Support
Laura Fennimore, DNP, RN
Gail Wolf, PhD, RN, FAAN
The complexities of healthcare demand new leader-
ship approaches to achieve organizational goals while
developing and sustaining healthy work environ-
ments. The nurse manager is the defining role, cru-
cial to achievement of workplace outcomes. Preparing
nurses for this dynamic, complex role is often depen-
dent on didactic education or on-the-job training that
falls short of true leadership development. The authors
describe an innovative approach to the development
of successful nursing leaders across an integrated
healthcare system.
Changing patterns in healthcare, including changes in
patients and providers, medical advances, information
technology, and reimbursement, create enormous
challenges for nursing leaders.1 Managing these
changes and driving strategic execution of goals re-
quire strong leadership that begins with adequate
preparation. However, studies indicate that frontline
managers are often the least prepared to handle these
challenges. Leadership development for nurse man-
agers is often loosely structured and fails to offer
experiences and mentors that assist nurse managers
to develop the competencies of successful leaders.2
Nurse managers are often selected for their positions
based on their clinical expertise, but they lack
confidence in topics ranging from human resource
management, preparing and monitoring budgets,
managing upward to senior colleagues, and using
technology in everyday practice.3-5 Being a successful
leader on the front lines requires not only clinical
expertise, but also the effective use of emotional and
cultural intelligence as well as energy management
skills.6 Chief nursing officers (CNOs) and other
nursing leaders in acute care hospitals describe com-
munication, conflict resolution, role transitioning,
scheduling, budgetary and payroll management, per-
formance evaluation, and staff counseling as the pri-
mary developmental needs for nurse managers.3
Establishment of a high-performing culture is the
critical element that distinguishes units where pa-
tients receive high-quality care from units where pa-
tient care is poor and unacceptable. Nurse managers
are Bchief culture builders[ who lead professionals
rather than just manage workers. They must be
competent in establishing healthy work environ-
ments through development of staff, effective dele-
gation, trust, and mentorship.7-9 Nursing leadership
is linked with the national patient safety agenda
through interventions targeted at preventing pres-
sure ulcers, reducing the incidence of central line
infections, and effective discharge planning to pre-
vent hospital readmissions within 30 days of patient
discharge. The attainment of ...
This monograph provides an assessment of the current hospital-physician landscape and outlines an innovative vehicle for advancing hospital-physician relationships that has the potential to improve care delivery and coordination, clinical quality, and patient cost. Our findings and recommendations address:• Changes in the market place.• The concept of an integrated medical staff model.• The role of operational clinical integration, enabled by an Electronic Medical• Record, toward creating virtual medical staffs.• Benefits to the hospital, physicians, patients and community.• What boards and senior management can do to move toward the model.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
Giovani medici jrsm
1. ESSAY
Why we cannot afford not
to engage junior doctors
in NHS leadership
Benjamin Brown1 • Yasmin Ahmed-Little2 • Emma Stanton3
1
Primary Care Academic Clinical Fellow, The University of Manchester, Health Services – Primary Care, Manchester M13
9PL, UK
2
Public Health Registrar, Mersey Deanery, Liverpool L3 4BL, UK
3
Commonwealth Fund Harkness Fellow and Psychiatry Registrar, South London and Maudsley NHS Foundation Trust,
Maudsley Hospital, London SE5 8AZ, UK
Correspondence to: Benjamin Brown. Email: Benjamin.Brown@NHS.net
DECLARATIONS Dubbed the ‘Nicholson Challenge’ by Health Disengagement of doctors can have disastrous
Select Committee chair, Stephen Dorrell, the consequences as highlighted at Maidstone and
Competing interests Tunbridge Wells, and Mid Staffordshire NHS
NHS must save £20 billion by 2015, or four per
All authors have cent per year. Monitor, the independent Foun- Trusts. Successful implementation of quality and
partaken in or have dation Trust (FT) regulator, has more recently indi- cost improvement initiatives in the NHS have
organized cated that this is more likely to be six per cent per been previously, in part, determined by the
leadership year. However, hospital productivity is falling and extent of doctors’ engagement.
development primary care trusts are failing to meet savings Sir Bruce Keogh, NHS medical director, has
schemes for junior targets. David Cameron has said: ‘It’s not that long championed junior doctors as an untapped
doctors in the NHS. we can’t afford to modernize; it’s that we can’t resource to improve the NHS:
afford not to modernize’.1
Funding and Despite preoccupation with the reform agenda, ‘Junior doctors who work closely with patients and
sponsorship the most pressing issue facing the NHS is the need alongside other members of staff on the shop floor
No external sources to increase value: maintaining and improving the 24 hours a day have penetrating insight into how
of funding or quality of care whilst saving money. To achieve things really work – where the frustrations and inef-
sponshorship were this, engagement of clinicians is essential. We ficiencies lie, where the safety threats lurk and how
received for this therefore cannot afford not to involve the junior quality of clinical care can be improved.’ 4
paper. doctor community. This article examines why
junior doctors are essential for the NHS to Nearly three-quarters of hospitals have no senior
Contribution achieve efficiency savings, why they are currently acute medical cover at weekends5 and medical
statement disengaged from the process and potential initiat- trainees often make clinical decisions that should
Benjamin Brown ives to address this. be made by senior colleagues.6 Failure to engage
prepared a draft of a component of the workforce responsible for so
this manuscript, to
much clinical activity will obstruct the NHS from
achieving significant savings.
which Yasmin
Why engage junior doctors
Ahmed-Little and
in NHS leadership?
Emma Stanton Why junior doctors may
contributed. Medical engagement is where doctors actively and be disengaged
Guarantor
positively contribute towards enhancing the per-
formance of the organization in which they work. The clinical-managerial divide
Benjamin Brown is
NHS hospitals with enhanced medical engagement General management was introduced to the NHS
nominated as the
perform better2 and those with more structured following the Griffiths report in 1983. The internal
guarantor for this
medical leadership initiatives have improved rates market in the early 1990s encouraged the health-
paper.
of hospital acquired infection, staff productivity care system to adopt more corporate behaviours
and financial performance.3 and was strengthened through a variety of policies
J R Soc Med 2012: 105: 105 –110. DOI 10.1258/jrsm.2012.110202 105
2. Journal of the Royal Society of Medicine
Reviewer under New Labour. This ‘managerialization’ Lack of organizational allegiance
Chris Ham of medicine has demoralized doctors and disen-
Nowadays, doctors activities are often driven by
gaged them from healthcare management,
external processes and targets, over which they
creating a ‘divide’ between clinicians and
have little personal investment or ownership.8
managers.7
Junior doctors’ contracts are rarely held by the
organizations in which they work and their induc-
Workload tion into the NHS is generally poor, both of which
may perpetuate a feeling of isolation. Furthermore,
Over the last 15 years, the New Deal and European
junior doctor jobs that used to be six months dur-
Working Time Directive has reduced the working
ation are now much shorter; along with the loss
hours of NHS junior doctors without decreasing
of free hospital accommodation, this reduces the
their workload. Currently, a single junior doctor
opportunity to build loyalty to their Trust.
may have primary responsibility for up to 400
patients at night. An apparent rise in sick leave
has placed further demand on those covering
Clinical leadership initiatives
rota gaps. To ensure junior doctors are adequately
trained within reduced working hours, they are
in the NHS
now also responsible for organizing regular,
The literature identifies four main ways to encou-
formal, work-based placed assessments of their
rage clinical leadership:9 – 12 training, development
skills. This may have, perversely, increased work-
and support; career structures; appropriate incen-
load. Many royal colleges also require member-
tives; and information systems.
ship exams to be completed earlier in training.
The net outcome is that junior doctors are under
increasing pressure to manage their clinical
responsibilities rather than engage with non- Training, development and support
clinical managerial activities. Despite leadership being a key responsibility for
doctors, formal training is notably absent from
undergraduate and postgraduate curricula,
Low morale leaving many senior medical managers feeling
Traditionally, doctors worked in ‘firms’, providing under-prepared.13 Currently, the majority of train-
continuity for patients and team members. ing manifests as ineffective short courses or formal
Reduced working hours mean hospital juniors qualifications, such as master’s degrees that
often work with different colleagues on a daily doctors must often complete in their own time.
basis, preventing the development of team camar- Established in 1990, the British Association of
aderie. In addition, shorter, more frequent and Medical Managers (BAMM) provided professional
irregular shift patterns may have paradoxically identity and support for doctors in management
worsened quality of life. Throughout the NHS, roles. It also recognized the importance of the next
junior doctors are now recruited to jobs via generation and had a highly active junior division.
central nationalized programs, which can make Despite ceasing operations in 2010, BAMM’s contri-
applicants feel de-humanized. This was particu- bution supported the development of the Medical
larly evident during the Medical Training Appli- Leadership Competency Framework (MLCF).14
cation Service debacle. A once guaranteed ‘job This outlines leadership competencies in five
for life’, junior doctors now face unfavourable domains that all doctors should achieve to become
job competition ratios, leaving many feeling more actively involved in the planning, delivery
uncertain about their future. Modernizing and transformation of health services (Figure 1).
Medical Careers (MMC) has introduced The framework has been supported and adopted
competency-based curricula, which have been cri- by all postgraduate medical royal colleges and
ticised as box-ticking exercises. Publically recog- incorporated into their curricula. Expedited by the
nized job titles such as ‘House Officer’ and cessation of BAMM, the Academy of Royal Colleges
‘Senior House Officer’ have been banished, with have established a Faculty of Medical Leadership
potentially de-professionalizing consequences. and Management (FMLM) that ‘aims to promote
106 J R Soc Med 2012: 105: 105 –110. DOI 10.1258/jrsm.2012.110202
3. Engaging junior doctors in NHS leadership
organized themselves into clinical directorates
Figure 1
based on pioneering work at Guy’s Hospital.
Medical Leadership Competency Framework
Since 1991 it has been mandatory for hospital
(reproduced from (1))14
boards to have medical directors. The directorate
model was implemented with variable success
and actively undermined by some doctors.
Whilst non-medical managers have largely
expressed satisfaction with this system, clinical
directors have been less positive,16 perhaps due
to a perceived lack of training.
In primary care, total purchasing pilots and,
more recently, practice-based commissioning
(PBC) have delegated budgetary responsibility
to GPs from health authorities and primary
care trusts respectively. Despite making only
modest improvements in healthcare services,
they have improved engagement of GPs in man-
agement.17 The current reforms could develop
this further, however, most organizations repre-
senting doctors, managers and patients remain
cautious.
Over the last few years, opportunities for junior
doctors to work as medical managers in a variety of
healthcare settings have emerged (Figure 2 and
the advancement of medical leadership, manage- Table 1). Further schemes incorporate quality
ment and quality improvement at all stages of the improvement capability into junior doctor train-
medical career for the benefit of patients’ (www. ing, such as Beyond Audit in the London
fmlm.ac.uk/about-us). This is a step towards Deanery and Learning to Make a Difference at the
medical management becoming a specialty with Royal College of Physicians. These have started to
professionally recognised accreditation. foster clinical engagement in a new generation
In the US, dual medical and management and whilst expensive to initiate, may achieve
degrees are increasingly popular, which UK
medical schools could consider. However, the
next generation of NHS doctors may favour more
informal mentoring, coaching and networking. In
Figure 2
London, Prepare to Lead provides mentorship for
Number of junior doctors in selected clinical lea-
junior medical leaders. A Buddy Scheme has also
dership schemes from 2008– 10
been developed in the North West of England,
which pairs trainee managers and doctors to
learn from each other and encourage clinical
engagement from an early stage.15 Organizations
such as The Network (www.the-network.org.uk)
and the North Western Medical Leadership
School formalize opportunities for like-minded
medics interested in clinical leadership to provide
support, opportunities and ideas.
Career structures
Doctors’ involvement in NHS management is not
new. Following the Griffiths report, most hospitals
J R Soc Med 2012: 105: 105 –110. DOI 10.1258/jrsm.2012.110202 107
4. Journal of the Royal Society of Medicine
Table 1
Leadership secondment opportunities for junior doctors in alphabetical order
Name of program Information
Darzi Fellowships In 2009, following recommendations from Lord Darzi’s Next
Stage Review, the London Deanery funded secondments
for junior doctors to learn more about health management
and quality improvement. This was spread to other
Strategic Health Authorities (SHAs) with funding from the
National Leadership Council. Each SHA has taken a
different approach to their fellowships, including the use of
used different names (‘Darzi Fellowships’, ‘Leadership
Fellowships’). Some are hosted at SHAs whilst others at
individual trusts. Some are ongoing whilst some have now
stopped due to lack of funding.
Leadership Foundation Programme Since 2009, Foundation Programme doctors have been able
to select programmes that include a rotation to provide
experience in medical management. Trusts that have
offered this track include Lancashire Teaching and Royal
Bolton Hospital.
National Leadership Council Clinical On 12th May 2011, Secretary of State Andrew Lansley
Leadership Fellowship Programme announced the creation of at least 60 clinical fellowships.
The first cohort of this multi-professional programme are
now in post for 2011/12.
NHS Medical Director’s Clinical Fellows Formerly the Chief Medical Officer’s Clinical Advisor
Scheme Scheme. The programme started in 2005 under Sir Liam
Donaldson and has catered for almost 50 junior doctors.
Recruits are seconded to work under medical directors in a
range of organizations such as the Department of Health,
National Institute for Health and Clinical Excellence, World
Health Organisation and BUPA.
NICE Scholars Opportunities since 2010 have been available for junior
doctors to work part-time at the National Institute for
Health and Clinical Excellence, developing quality
standards for the NHS.
North West Junior Doctors Started in 2002, this is ostensibly the first full-time
Advisory Team programme for UK junior doctors. Operating across the
SHA and post-graduate deanery, they were initially set up
to facilitate compliance with the European Working Time
Directive. Their remit now covers more broadly education
and workforce issues for North West junior doctors.
North Western Medical Leadership Started in 2008, this programme provides part-time
Programme experience in medical management alongside clinical
training for Specialty Trainees. Training is extended by a
number of years and participants study towards a degree
in Healthcare Leadership.
Third sector opportunities These opportunities are becoming more popular with
clinicians, who can work as non-clinical consultants on
freelance projects. Such opportunities include McKinsey
and Company, a management consultancy with a
healthcare division, or Diagnosis, a clinical leadership
social enterprise.
108 J R Soc Med 2012: 105: 105 –110. DOI 10.1258/jrsm.2012.110202
5. Engaging junior doctors in NHS leadership
savings for organizations in the longer-term.18 Conclusion
However, despite these initiatives, still no formal
career structures for aspiring clinical leaders exist As the NHS prepares for an ‘era of austerity’, over
and could be developed, similar to reforms that 40,000 junior doctors are an, as yet, untapped
have taken place in academic medicine. resource to systematically improve value. Not
engaging this group is like ‘trying to improve
skiing by changing the rules of competition, the
Appropriate incentives colour of the medals, and the location of the hill
Pay for doctors who move into leadership roles without spending much time at all on changes in
can often decrease.11 Whilst money is not the skiing itself’.20 Learning from past experiences,
major factor in motivating clinicians, losing our paper outlines some routes to improving
income may be a strong deterrent. This is particu- medical engagement of junior doctors, as well as
larly relevant given overall decreasing pay, pen- a specific call for training the next generation of
sions and uncertain future of clinical excellence clinical leaders to commission services.
awards. Encouraging junior doctors to engage in
leadership through quality improvement pro-
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