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Umesh-Prabhu-2

Tipster extended play: how to work with doctors

Mon 23 Oct 2017

With patient demand rising as the funding noose tightens, relations between doctors and managers can become strained. But it doesn’t have to be like this. Umesh Prabhu shares more of his tips for working more effectively with your medical colleagues.

  1. Respect each other and work together
  2. Get to know doctors
  3. Talk the same language
  4. Show doctors the evidence
  5. Ask doctors for help
  6. Train doctors and manager together
  7. Find the best leaders
  8. Don’t be intimidated!
  9. Take responsibility
  10. Give doctors a sense of belonging

1. Respect each other and work together

Success is when we all work together for a common purpose, and in the NHS our purpose is our patients. Good team working is crucial for good patient care.

Doctors and managers often have an uneasy relationship because both are under severe pressure for different reasons. Doctors are struggling to provide the best care, but there isn’t enough money and they often have to work within poor systems and processes. Managers have to manage budgets and meet targets. To work together, you must make the effort to understand each other’s difficulties and needs. Doctors and managers want the same things: to be respected, to be listened to, to be engaged, to receive praise, to be valued and to be challenged.

2. Get to know doctors

Go and meet the doctors in your organisation. Listen to their day-to-day frustrations and challenges. Ask them, “What’s your plan? What’s your vision? How can I help you improve patient care?” Get to know everyone’s strengths and weaknesses so you can help build a winning team. 

Most doctors want to provide the best care for their patients. In my experience, around 80% of doctors are reasonable and easy to deal with; they understand managers’ frustrations and challenges, and want to work with them. The rest may be cynical and difficult, or poor team players, and some will be resistant to change. But most of those can be helped – only 1-2% are actually bad doctors. Even with the most difficult doctors, try to understand their frustrations and why they behave as they do.

When you’ve got a problem, talk to the most co-operative and engaged doctors first. Get them on your side and let them tackle the more difficult doctors. And always try to talk to doctors individually. Doctors are fiercely competitive and, in a group, the herd mentality takes over. Only the most vocal people will talk, and they will usually be the consultants who don’t want change.

3. Talk the same language

As a manager, your job is to get the best care for your patients within the available resources. But most doctors and nurses don’t think about resources; their instincts are to think only about patient safety. This is not because doctors want to be difficult, but because we don’t train doctors about cost, efficiency, value for money and so on. 

So, when you talk to doctors, you need to change your language. Don’t tell doctors you want to save money, tell them you want to use resources more effectively to improve the quality and safety of services. And then ask them: how can you help? 

At Wigan, I told the finance staff not to talk about the cost improvement programme (CIP), but to talk about safety, quality and how clinical staff can help us to use the available money more wisely and effectively. On many occasions, the clinical teams came up with ideas about how to provide safer and better care – and how to save money at the same time.

4. Show doctors the evidence

Doctors like data. If you tell me, “Umesh, you’re wasting money, we’re going to do X”, I won’t want to co-operate. But doctors are fiercely competitive and no doctor likes to be in the bottom of the table. So, if you show me all the relevant financial and performance information, I’ll be interested and will want to improve my performance.

If a doctor is underperforming, start an honest dialogue with them about finding a solution. But make sure you’ve got your figures right. Doctors will quickly spot errors, and once you’ve got it wrong two or three times they won’t trust you anymore. Use your clinical and medical directors to help you tackle the small number of really difficult doctors.

5. Ask doctors for help

Like most people, doctors hate being told what to do. But if you respect doctors and ask them for help, most will be very happy to work with you to find a solution. Managers don’t involve doctors enough in decisions about finances and meeting targets, and doctors don’t take enough interest in them. But doctors are very competent, very bright and like solving complex problems – so don’t waste the skilled resources at your disposal.

6. Train doctors and managers together

I believe teaching doctors to be good leaders is the key to transforming the NHS. But you have to train clinical and non-clinical managers together. Training should be tailored to your own staff and take place within your own organisation, not at a hotel with managers and doctors from many different hospitals.

At Wigan, our HR department produced an excellent training package for senior nurses and consultants, with a more intense eight-day training programme for anyone who wants to be director or senior manager. The key thing is learning to understand each other and working together as a team. Our training covered the impact of behaviour on each other, leadership skills, clinical governance, team working, patient safety, finance and value for money, change management and good HR practice, as well as dealing with difficult colleagues and having difficult conversations.

Most doctors don’t know how much we spend on the NHS, how many patients die due to medical errors or how many patients have been waiting more than six months. You’ve got to know the basics if you want to be a leader.

7. Find the best leaders

Not all doctors are cut out to be leaders – and it has nothing to do with how good a doctor they are. The key is identify the ones who want to want to be leaders and have the personality for leadership. Handpick your leaders by talking to nurses, junior doctors, GPs and so on. I asked just five questions: Who’s the best consultant? Who’s a nice human being? Who’s a good team player? Who do you want to see as the leader? And why?

Good leaders learn from their junior colleagues. I remember a junior doctor coming into my room in tears after I’d shouted at her in front of a patient about a mistake she’d made. I was mortified. I realised I was focusing so much on the patient, I’d forgotten she was a human being. That day, I learnt one of the most important lessons of my life: you must give positive and negative feedback to juniors but, when it comes to criticism, give it quietly and privately.

Everyone knows my mantra by now: “happy staff, happy patients”. It’s a leader’s job to make that happen.

8. Don’t be intimidated

Some doctors are a nightmare to manage, but most are very easy to inspire and lead. Many doctors see managers as people who tell them what to do and blame them when things go wrong. But a leader listens to you, and inspires and engages you. 

Doctors can be intimidating, but the worst thing managers can do is avoid difficult doctors and talk only to nurses or a handful of co-operative or quiet doctors. This usually upsets other doctors and makes them even more cynical. Not all doctors are easy to please or work with but, if you open a dialogue with them, you’ll be surprised how co-operative they can be.

9. Take responsibility

As a manager, there’s only so much you can do. Be honest about what you can change. Try to solve issues locally by working with doctors. If patient safety or quality of care is at risk, talk to the clinical or medical director or raise it with your own seniors. Take it to the board if you have to. Patient safety and quality of care is everyone’s job.

It’s very important to have a robust system of clinical governance, where anyone can raise concerns and feel they will be taken seriously. This means everyone is accountable for their behaviour and everyone gives feedback and support. Too much NHS management is reactive – responding to problems with disciplinary action and sanctions, rather than nipping problems in the bud, listening to staff and supporting them to make changes. 

We need to remove the culture of blaming, shaming, discipline, humiliation and punishment. Talk to doctors and resolve issues early and quickly, but never compromise patient safety, quality of care or good team building. 

10. Give doctors a sense of belonging

Doctors’ primary loyalty will always be to the patient, and that’s the way it should be. While many doctors also feel loyal towards the NHS as a whole, many feel little sense of attachment their employing organisations. 

Trusts feel like remote bureaucratic institutions, sitting in ivory towers and managing doctors. Most staff don’t know who the chief executive or board members are – and fewer still have met them. It’s really important that board members mix with staff, understand their day-to-day frustrations, and help and engage with them. 

Some boards meet staff regularly, welcome them to their meetings, and have members who go on patient safety walkabouts and so on. These boards do very well. At Wigan we invited junior doctors and consultants to attend trust board meetings, and board-level safety and quality meetings – this made them realise how hard board members work and helped to bring clinicians and managers together. It’s vitally important for us to understand each other’s difficulties and challenges and work together to provide the best and safest care for patients.

When even the most junior doctor feels they can go to the medical director, you’ll know you’re getting the culture right.

  • Umesh Prabhu was medical director at the multi-award winning Wrightington, Wigan and Leigh Foundation Trust from 2010 to 2017. This is an extended version of the article published in the Autumn 2017 issue of Healthcare Manager.

 

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