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Difficult issues for Clinical Directors

Gabriel Sayer Divisional Director for Surgery and Consultant General and Vascular Surgeon at Barking Havering & Redbridge University Hospitals NHS Trust gives an update at today’s Effective Clinical Director conference on:

  • managing the team: conflict resolution
  • managing complaints
  • demonstrating patient safety and identifying risks
  • my experience as a Clinical Director

Gabriel Sayer's full presentation is available for download at the end of this page.

Abstract of Gabriel Sayer's presentation

Summary of Talk

  • The essential conflict of being a Clinical Director
  • Building and Managing the team
  • Managing complaints
  • Demonstrating Patient Safety and Identifying Risk

Being an effective Clinical Director necessitates skills in addressing the conflict between being both a Clinical Leader and a Clinical Manager. As a Leader you are required to give direction and vision to the services you lead, while enabling your team to deliver to the best of their abilities. As a Manager you must align with the Trust’s goals and objectives such as meeting financial targets. These (often) opposing priorities may provoke conflicts. For example the tension between quality versus quantity: as a clinical manager we have to recognise these are often co-dependent. To be effective in your role it is therefore important that you develop the skills that will be crucial to your future success.

Building a Team

Having taken on the role of a CD the next steps are to ensure you have the resource and team behind you to be successful. Maslow’s hierarchy of needs describes a structured representation of the layers required for human development and achievment. I have adapted this to identify what you need to be successful as a CD. At its most basic you need to have a job specification that you think is achievable, a secretary, adequate time and organisation support for the role you are undertaking. In addition it is worth thinking about what type of leader you want to be. When Tony Blair asked Bill Clinton for advice at the beginning of his tenure as prime minister he told him to “Think about your legacy”. While this may not have been heeded so well by Mr Blair, it is good advice. When you start as a CD think about how you wish to be perceived and what you would like to have achieved when your role is finished. Building on the basics you then need to ensure you have a team around you that will enable success. You need good general manager, strong support from your colleagues in nursing and a clear understanding of who does what work. So think about how you will achieve this.????

When you have a clear team infrastructure you need to ensure you have the necessary meetings, to enable you to communicate your vision of leadership and to get the information you need to be effective in your role. Communication is the key and the one area where time commitment will be rewarding in the long term. Remember meetings should have a clear purpose defined by an agenda and some terms of reference. In general business meetings should be about making decisions, if they become long talking shops with little outcome progress is likely to be slow. If you are not confident in chairing meetings then start to get feedback from others and think about what a well chaired meeting feels like- can you recreate this?

With your team and infrastructure in place you are ready to start the real work!

Managing Complaints

Complaints will come in many forms. The easy ones to identify come from your PALS office or similar (Hospital patients complaints and admin team) who will field a large number of the routine complaints. In among these will be a number that raise more important issues that need to be brought your attention, make sure you have got a complaints officer who knows what they are doing! Some complaints will be raised via more informal channels whether it be via NHS choices, an email to the chief executive or an anonymous tip off. My advice is to treat them all with the same degree of professionalism and thoroughness. Complaints are one of your key reference points in identifying risk and performance of individuals and services; they should be seen, at least in part, as a reflection of how your services are doing and how they are perceived.

Learn to quickly assess how “serious” a complaint is and how to decide whether this is likely to be an SI or lead to significant HR issue. All complaints need to be resolved whether informally or formally. Resolving a “serious complaint” with an informal process is not recipe for success. Knowing how to conduct a formal investigation is crucial, and having the process conducted in a timely manner will require adequate support from your HR team. Knowing when something is formal or informal can be more challenging and merits discussion with your Medical Director.

Demonstrating Patient Safety and Identifying Risk

As a Clinical Leader you are always on show. “The standards you walk past are the standards you accept”. Your team will look to you to set the standards and to follow them. Patient safety requires that we follow procedures and protocols and where we vary from such guidelines we do so with good cause. All episodes of avoidable patient harm should be investigated and the learning from this shared and implemented. To achieve this you need an effective governance or quality and safety team and an established safety culture.

To improve your patient safety culture you have to develop trust and empowerment of those who are sighted of the risks. These people are often those who have the least voice and as such need support and enablement. If your patient safety culture is dependent on top down leadership you will not get the engagement of those who will truly make a difference. Having identified risk it is important that you know how to quantify the risk and to act upon it. Learn about how your trust undertakes local and corporate risk assessment- no one likes to find out about a major risk they are unsighted to least of all your executive team at their trust board meeting.

Gabriel Sayer's Biography:

I have worked as a Consultant and Vascular Surgeon at BHRUT NHS Trust for ten years. In this time I have been Director for Trauma Services, CD for Vascular Surgery, CD for Specialty Surgery and I am now Divisional Director for Surgery. I have been involved in several major service reconfigurations, including the development of London Major Trauma Centres, and leading centralisation of Vascular services in NE Outer London. I have experienced four different CEOs during this time and have considerable experience of working in a challenged environment.

Future conferences of interest:

A Practical Guide to Improving Outpatient Services
Monday 21 September 2015 , Hallam Conference Centre, London

Clinical Audit for Improvement
Wednesday 7 October 2015 , Colmore Gate Conference Centre, Birmingham

Expert Witness Intensive Training Course: 2 Day
Thursday 15 October 2015 — Friday 16 October , Hallam Conference Centre, London

Setting Up and Running Virtual Clinics
Monday 19 October 2015 , Hallam Conference Centre, London

Effective Clinical Director
Tuesday 3 November 2015 , ICO Conference Centre, London

Delivering a 7 Day Health Service
Monday 9 November 2015, Hallam Conference Centre, London

Clinical Audit Masterclass
Tuesday 10 November 2015, Hallam Conference Centre, London

National PROMs Summit 2015
Tuesday 1 December 2015, Colmore Gate, Birmingham

Electronic Document Management in Healthcare: Delivering a Paperless NHS
Wednesday 9 December 2015, ICO Conference Centre, London

Download: gabriel-sayer-web_1235.pdf

3 November 2015


    Partner Organisations

    The Tavistock and Portman NHS Foundation TrustInPracticeClinical Audit Support CentrePlayoutJust For Nurses
    GGI (Good Governance Institute) accredited conferences CPD Member ASGBI (Association of Surgeons of Great Britain and Ireland) professional partner BADS (British Association of Day Surgery) accredited conferences