Three ways health care has to change

At the weekend I read an insightful publication from The King's Fund, a UK organisation that reviews and makes recommendations about health policy. It's about 50 pages long, but for me the take away messages are summarised below. The original publication is here.

The way we work needs to change in 3 ways, and all have the potential for big reward for both professionals and patients of the future. And if you're a junior doctor or medical student - don't switch off, this is especially important for you!

  1. Greater focus on engagement
  2. Leaders at all levels
  3. A new approach by hospital management

1. Focus on engagement
The principle values that underpin engagement in our workplace are those of:

  • openness
  • collaboration
  • empathy
  • listening to and supporting each individual

There is clear evidence in healthcare that having an engaged workforce results in reduced stress, reduced absenteeism, increased motivation, fewer errors, lower hospital infection rates and even reduced mortality. Happy staff = happy patients.

We build an engaged workforce by focusing on both individuals and teams within the hospital. All staff need:

  • An understanding of the values of the organisation
  • Clear tasks
  • Satisfying jobs that utilise their skill set
  • Groups to be brought together in a meaningful way
  • A team focus on quality
  • Autonomy & involvement in decision making
  • Encouragement and celebration of success

2. Leaders at all levels
There is a growing recognition that to be a good doctor of the future, it's no longer enough to be head-down in clinical work. Intense sub-specialisation and the devolution of many aspects of care to the wider MDT, means that we all need the skills to help build and be part of an effective team. We all need leadership skills - and from day one of the job.

There is a need for medical leadership to be taught in medical schools, for every doctor to recognise that their role as a professional is not limited to clinics, ward work or the operating theatre. These are the baseline expects. All doctors need to understand the dynamics of the teams they work in, appreciate the values they personally bring to, and adopt within, the service. We need to invest energy in the relationships and behaviours that will make our whole team a success.

Leadership isn’t about being an extraordinary person, it’s about being open and accessible, with an emphasis on team work, collaboration and removing barriers to communication. It reflects a desire to see the world through the eyes of others, taking on their perspectives and working with their ideas. Often, it’s about challenging the status quo.

So how do you start being a leader? You start now, right where you are, with the people and teams that you interact with on a daily basis. Think about how you can bring a focus of engagement to those around you. Find others to share the enthusiasm and help them too. And look out for opportunities to engage with managers who are open to a new approach in how they work as well.

3. Management: devolved authority
For too long the pervasive style of senior hospital management has been ‘top down’, a command and control culture, with a demanding focus on targets (e.g. Emergency Department access times, surgical waiting lists, etc). Recognition and reward is closely linked, ensuring the medical and nursing teams are constantly paying attention to these priorities - not that they aren't worthy, but often it's to the exclusion of clinical and team goals of an equal or greater importance.

Unfortunately, in many hospitals, a target-focus has been linked with a reluctance to delegate control to middle managers and senior clinicians. Staff become robbed of the authority to make decisions, there is a reluctance to collaborate with teams about changes that directly affect them, leading to demoralisation and ultimately poor patient care.

We need a new management style to breathe life into our hospitals. We need hospital managers to recognise the importance of engaging both patients and staff, with a rethink of the way power and responsibility is distributed within organisations. If there are problems on the floor, senior medical and nursing staff should be consulted about the issues and engaged to find solutions. They are usually in the best position to understand the dynamics of what will and what won’t work.

Managers need to bring clinicians into leadership roles, ensure that leadership and decision-making is distributed throughout the organisation. Control over how clinicians do their job is the biggest predictor of an engaged, happy and functional workforce - 'no decision about me, without me'


If you think this is important, join the positive leadership movement and talk about these issues. Share/like on social media, so others know you believe in it and the word spreads. Be the change you want to see in our health care systems.