Intended for healthcare professionals


Welcome to your new hospital

BMJ 2022; 378 doi: (Published 02 August 2022) Cite this as: BMJ 2022;378:o1907
  1. Adrian Boyle, consultant in emergency medicine, president elect12
  1. 1Cambridge University Hospitals NHS Trust
  2. 2Royal College of Emergency Medicine

August is a month of mass medical migration. Postgraduate doctors are scattered across UK hospitals, and for some, this is their first experience of a workplace as a professional or even their first experience of working in a new country. For others, they leave one hospital after a night shift and find themselves expected to magically teleport themselves to another hospital’s compulsory induction that same day. It seems perverse to change a large proportion of the workforce all on the same day and human resource departments are frequently overwhelmed in a predictable “capacity demand incident.” Permanent staff, who know how to get things done, become even more valuable in August.

First impressions matter, and hospitals aren’t always good at this. Hotels know that quick and friendly check in and check out times are disproportionately related to guest satisfaction and are often very slick. In a hospital, knowing how to park, get a badge, find your rota and sort out passwords shouldn’t be difficult—even at scale. The mandatory nature of induction programmes, either online or face to face in a lecture theatre of strangers, often feel more designed to tick some governance box rather than establish good working relationships. We’re getting better at some of this, but the waste of human time on induction is staggering. Reforming induction should start by considering what the end outcome should be. There will always need to be some corporate governance so that staff know how the hospital is organised, but surely the aim should be to make new staff capable and effective as efficiently as possible? Any information that is generic to the NHS should not need repeating at every new hospital, especially for people who are returning.

There is quite a large management literature about what is effective in introducing new staff to large organisations. Unsurprisingly culture and leadership really matter. The final aim of this should be to create a learning environment where young doctors can safely and efficiently learn how to do their job.

Consultants who explicitly explain their reasoning by “thinking out loud” and take a pastoral interest develop juniors more quickly. Peer support seems obvious, but has become harder with online teaching and infection prevention and control measures. Being able to share intelligence about how systems work with the person sitting alongside quickly creates “herd knowledge.” Social acceptance is an important indicator of how a newcomer is inducted and important for enjoying work. Individual departments should actively consider planned social events early to build a team and photo boards of staff explicitly signal that new staff are valued and seen as part of the team. Starting work in a new hospital can be daunting, let’s make it better.


  • Competing interests: AB has received grants from the Health Foundation and Small Business Research Initiative to investigate emergency department crowding. AB consults to ElectronRx.

  • Provenance and peer review: commissioned, not peer reviewed.

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