Inspirational leadersBMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e3062 (Published 03 May 2012) Cite this as: BMJ 2012;344:e3062
- Kathy Oxtoby, freelance journalist
Motivational and inspirational leaders can encourage clinical teams to achieve real service improvements. But to transform services they will face challenges, such as budgetary constraints and resistance to change.
The four finalists for the BMJ Group award for clinical leader have not only overcome obstacles to bring about change but can also show a measurable improvement in patient care.
Jon Cardy, West Suffolk NHS Foundation Trust
Before Jon Cardy became clinical director for accident and emergency services at West Suffolk NHS Foundation Trust in 2011, the department had failed year on year to meet national quality standards. But within a month of his taking on this post, his department achieved a dramatic improvement across a range of measures of quality performance, hitting and maintaining the number one position in the country on the four hour wait standard.
One of the challenges Cardy faced was that West Suffolk emergency department was designed to manage many fewer than half the number of patients that currently attend. He worked tirelessly on improving interdepartmental cooperation and enhancing patient flow by gaining hospital-wide support to improve the urgent care pathway.
Cardy stood “shoulder to shoulder” with his team to get the job done, “because I wouldn’t expect anyone to do anything I wouldn’t do myself,” he says. He has boosted team morale and helped colleagues realise their potential.
His efforts have been rewarded by the positive feedback he has received from other clinicians, and by seeing a team with previously poor morale “light up with renewed passion for their work and telling me they feel empowered to do things differently,” he says. “Seeing smiles on faces, even after a challenging shift, makes this work worthwhile.”
John C John, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry
John C John is a consultant anaesthetist at one of the largest elective orthopaedic hospitals in the UK, where up to 2800 joint replacements are carried out every year. John has led the introduction of a new approach to speed up the rehabilitation process for patients, which has significantly reduced the length of stay after surgery.
Traditional analgesia in joint replacement procedures has drawbacks for recovery: morphine can cause nausea and sedation, while nerve blocks cause muscle weakness, which delays patients’ mobility until the first or second day after their procedure. John’s vision was to replace anaesthetist led techniques with intra-articular local anaesthetic infiltration by surgeons.
Achieving this required a complete change in analgesic techniques and a cultural transformation within the trust. John overcame resistance to change by showing through his own practice how effective the new method was, highlighting to clinicians the quicker recovery and that some patients were able to go home within a day after having a joint replacement.
John ensured that clinicians were involved in the project from the start to avoid their feeling alienated and give them a sense of ownership. He describes his leadership style as “inspirational and enthusiastic.” He says: “Being passionate about the project, and feeding back to colleagues how much patients love this programme has helped to inspire the team.”
Pradeep Khanna, Aneurin Bevan Health Board
Managing chronic conditions and frailty in adults is a considerable challenge for health and social care. As clinical leader for the Gwent Frailty Programme, Pradeep Khanna has been instrumental in uniting local authorities, health boards, and voluntary organisations in the region to work together to benefit frail people in a holistic way.
Responding to Khanna’s belief that the healthcare needs of many frail patients are best served in their own homes, rather than in secondary care, the Welsh Assembly Government has invested £6.9m (€8.6m; $11.3m) to support the Gwent Frailty Programme. Thanks to his drive, leadership skills, and influence, health and social care organisations in the Gwent area now work as one, with a single budget to improve patient outcomes and support care within communities. The programme has considerably reduced the time people spend in hospital, producing substantial savings and increased patient satisfaction.
Having a clear vision, seeing “the big picture,” and being single minded and focused are qualities that have helped Khanna to break down organisational barriers and unite services for the benefit of patients. “You have to be totally on the side of patients—and I’m passionate about looking after them,” he says.
Duwarakan Satchithanand, University Hospital of North Staffordshire
In 2007, a Healthcare Commission report suggested that the University Hospital of North Staffordshire was one of the worst performing hospitals for heart failure in the country. Since becoming clinical lead for heart failure in 2008, Duwarakan Satchithanand has transformed the care of patients.
He has implemented two interventions for the management of symptomatic and worsening heart failure within an overall programme of change. The first intervention provides community based subcutaneous diuretics for relief of symptoms in the palliative care of patients with heart failure. The second offers what would have been standard inpatient care in heart failure—including intravenous diuretics—on an outpatient basis through an ambulatory heart failure unit.
These changes have led to better links with primary care and community teams caring for patients with heart failure and a strong relationship between palliative care and heart failure teams. Patients have welcomed the initiative, and in one year the scheme has reduced hospital admissions for palliative care patients by 350 bed days.
Satchithanand has also boosted staff morale by encouraging them to develop their skills and leading from the front by example. “Staff were feeling demoralised and their practices were old fashioned. I introduced a teaching regime that has changed the way they work and given them more confidence. I like to think I can inspire people to do better,” he says.
Cite this as: BMJ 2012;344:e3062
For more about the BMJ Group awards go to http://groupawards.bmj.com.