Geriatricians as leaders and managers to improve care

Dr Louise Southern is a registrar in General Medicine and Care of the Elderly in the north-east. In this blog, she discusses her experiences of the National Medical Director’s Clinical Fellow scheme.

Last year I became the first trainee in geriatrics selected onto the National Medical Director’s Clinical Fellow scheme, and spent 12 months on ‘out of program experience’, completing this Fellowship, hosted by the Faculty of Leadership and Management. As this year’s recruitment process is now underway, I’ve been reflecting on what made me apply, and how it has affected my subsequent practice.

How we built a Geriatric Service in the ‘largest hospital in Europe’

Caroline Whitton is a Geriatrician working in NHS Greater Glasgow and Clyde currently based in the Victoria Infirmary, Glasgow which is soon to be subsumed into the South Glasgow University Hospital. She has several educational roles which include Foundation Programme Director, Consortium Lead for NHS Education Scotland and Associate Director of Medical Education for NHS Greater Glasgow and Clyde.

For me, the adventure began when I was asked to deputise for my Clinical Director at a meeting to discuss junior doctor staffing of a new admissions unit. The meeting was hosted by the medical directorate, and I was the lone geriatric voice amongst a cast of many. From that meeting began a process that has, for the time being, taken over my professional life! Do I regret my initial impulse to go along? No – because it initiated a journey which has enabled me to be involved with the design of a completely new service. It has made it possible for me to influence the way in which I provide care to my patients and deliver training to my junior colleagues.

BGS Spring Meeting

Tom Dening is a Professor of Dementia Research at the Institute of Mental Health, University of Nottingham. 

Spring in Nottingham! What could be finer? Little spring flowers bursting out all over University Park, Nottingham Forest on the verge of play-off contention, the ice floes beginning to break up on the Trent, students shedding their furry parkas and starting to sit on the grass….

And what better way to spend your time than to check into to the East Midlands Conference Centre at the end of April for the BGS Spring Meeting? Even better, stay at the eco-friendly Orchard Hotel next door and barely have to move for 3 days. The programme has been finalised, and booking is in full swing! I’ve even forgiven them for spelling my name wrong in the advertising booklet.

I have been (peripherally) involved in the organisation of this event, which has been led by my colleague Rowan Harwood form Nottingham and the BGS events team; it’s the first time I have worked with the BGS on something of this kind. The planning for the event started about 2 years ago, so clearly a lot of time and thought has gone into the final agenda. The programme has got something for everyone and most people will probably be interested in quite a lot of the sessions. I’m of course pleased to see that there’s a whole day for the Dementia Special Interest Group but also a session on the first morning of the main conference about aggression, with three top class psychiatrists/psychologists.

My own contribution is to co-facilitate a workshop on The Geriatrician as Manager, with Stephen Fowlie, who is the Medical Director of Nottingham University Hospitals NHS Trust. He’s the real deal, being a current MD (as opposed to being an ex, in my case) and a real geriatrician (as opposed to a psycho-, as in my case). Why have we suggested this session, and what relevance has it alongside topics like falls, respiratory disease, infections and so on?

Everyone probably has their own thoughts on doctors and management, but in many ways management and clinical medicine are inseparable. In almost every case, it’s not just us doctors dealing with individual patients and their families. There are hosts of other people, especially in the typical geriatric medicine scenario of multiple complex morbidity, where the outcomes are damage limitation or end of life care, rather than cure and restitution of full function. Some of these others are members of your own clinical team, but many of them are not. They include the support staff in the hospital, for example cleaners, caterers and porters, but also (obviously indirectly!) the finance team and ultimately the Trust Board. These latter folk help to determine the success of the hospital, dealing with commissioners, regulators, the media and the public, and these things in turn influence what your hospital is like to work in.

The job of the doctor starts with assessing and treating patients as they are admitted, and extends beyond this into the relationship that they have with their clinical team. But it goes further: what we do at the coal face gets translated into the data supplying both the people who buy our services (commissioners) and those who oversee them (regulators, the CQC in particular). There is no clear cut-off point dividing our clinical activity and these other processes. Some doctors relish the complexity and the challenge of dealing with hospital systems: they may  for example show an aptitude for the politics, or they may see engaging with management tasks as a potent way to get things done. It is this area that Stephen and I will be looking to explore in our workshop, and we look forward to meeting you in Nottingham

Photo credit: 3dpete via flickr.

Leading The Way

Sarah Blayney is a Clinical Fellow in the Calgary Stroke Program at Foothills Hospital, University of Calgary. In this blog, she recounts her experience of attending the first BGS Leadership Conference in November.

After nearly nine months of trying to fit into an academic neurology department, it was a huge relief to find myself surrounded by geriatricians once again. My sense of adventure took me to Canada on a stroke fellowship earlier this year, in what I thought would be a refreshing break from the trials and tribulations of life as a medical registrar in today’s NHS. The calibre of stroke training is second to none, and learning to think like a ‘Calgary stroke neurologist’ has sharpened my clinical approach far more than I anticipated.

However I have also come to fully understand the meaning of silos within healthcare, and the effect this can have for patients with multiple medical problems.  The department is well led, with highly motivated teams across acute and rehab units, outpatients, research offices and clerical staff, but it pains me every time our service backs off from the care of a frail elderly patient deemed unlikely to benefit from admission to the acute stroke unit (though occasionally I sneak one in when I can). Our response time to acute stroke patients is excellent, but for those that turn out not to be stroke, it can mean a delay in getting them to the right place as well as multiple reviews by different people along the way.

It was in this frame of mind that I returned to the UK for a fortnight of courses and conferences to ensure a smooth CCT sign-off when I return in the spring.  Word had got round about the first BGS Management Course run last year and I was keen to get back for this year’s course if at all possible; it proved to be the highlight of my trip.  We are all too aware of the problems currently facing the NHS, but the pre-course reading list opened my eyes to the volume of resources being generated to combat these problems.  I find everything I have seen so far from the King’s Fund to be particularly practical and insightful, unlike some of the political statements that come from elsewhere. This set the tone neatly for a well thought out two days of discussions and workshops. Aspirations are important, but sharing best practice and brainstorming potential pitfalls is essential when it comes to rolling up our sleeves and making these aspirations real, and the course delivered just that.

Simulation is such a useful way of making the leap from theoretical discussion to a real life interaction, so roleplay and “Dragons Den” style workshops were a fun and very practical way of exploring some of the issues we may face as future consultants. Birmingham City Council obliged in making this even more true to life by issuing a parking ticket just before one such mock ‘management meeting’, very effectively raising the frustration levels of our acting medical director! The opportunity to ask questions, as well as be put on the spot, created a stimulating environment. The course timetable had clearly been planned to reinforce this, as regular coffee breaks allowed conversations to continue and develop outside of the structured sessions.

Hearing anecdotes on the second day from our course facilitators about their own experiences in developing new services was a tidy way of drawing together the principles we had explored earlier.  It also prepared me well for the task ahead of finding the right consultant job, and clarified my thoughts as to the direction my career may take in the next five years.  My other half recently challenged me on my use of the term ‘dynamic young geriatricians’ when I described to him the BGS course faculty, and this did give me pause for thought (as a surgical registrar who has encountered Dr Wyrko at work, he has his own ideas of what dynamic might mean in this context).  The last thing I would wish would be to appear ageist towards my older and wiser consultant colleagues, many of whom have taught me a great deal over the last nine years, but I am sure they would agree that the hospital world is changing.

We as a generation of trainees have been in the thick of it when it comes to the current state of acute hospital medicine, and have developed a different expectation of what our future working life will look like as a result.  My experiences as both a UK stroke registrar and a Canadian stroke fellow have only served to strengthen my conviction that our frail elderly patients deserve faster, better care than the NHS can currently offer in many places.  My two days under the expert coaching of Drs Gordon, Wyrko, Conroy, Blundell, Long and Oliver have provided the insight and skills to play my part in making this happen.

Image credit: Ascent Magazine via flickr.