Education And Debate

Management for Doctors: Effective top teams: luxury or necessity?

BMJ 1994; 309 doi: (Published 17 December 1994) Cite this as: BMJ 1994;309:1653
  1. Andrew Kakabadse,
  2. Hugh Smyllie
  1. Cranfield School of Management, Cranfield MK43 0AL, professor of management development.
  2. Trent Health Authority, Sheffield S10 3TH, facilitator, Network for Trent Medical Managers.

    Case study

    At a Medical Advisory Committee meeting in 1987 the consultant in accident and emergency proposed that, in the light of a recent report by the Royal College of Physicians criticising the standard of cardiopulmonary resuscitation (CPR) in hospitals,1 our district general hospital should review its training and procedures in CPR. The meeting agreed to form a subcommittee under the aegis of the consultant anaesthetist in charge of the intensive therapy unit. Other members were to be the proposer, the consultant responsible for the coronary care unit, that unit's sister in charge, and a junior doctor. Also included was the senior operating department assistant because he and his colleagues were important members of the crash team bringing the crash trolley and performing intubation. The subcommittee chairman obtained advice from a regional cardiac centre that had already revised its CPR training and procedures.

    The subcommittee duly met. Its members were defensive of their various roles and departments, there was an acrimonious clash of personalities between consultants, and the meeting broke up having achieved nothing.

    No further attempt was made to pursue the issue until 1991, by which time the district general hospital had become an NHS trust. One of the trust's early decisions was to develop a resuscitation policy to include procedures and training. The task was allocated to the medical director, who delegated it to the clinical director of anaesthetics, whose directorate included operating theatres. This anaesthetist became the chair of a new working party on CPR. He was advised to limit the working party to four consultants, two of whom had been on the previous subcommittee. He was also advised to seek opinions from relevant experts within and, if necessary, outside the hospital.

    Initially, he approached members and experts individually to indicate those aspects on which they should contribute …

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