On the 1st of August 2012 I will be taking up the post of Medical Director at a large NHS Trust in the Midlands UK.

This blog is an outline of my journey to this critical juncture of my career and I intend to use it to share my experiences in this role and I hope to help others – either actual or aspiring medical directors – in their journeys too.

It is my belief that too few doctors put themselves forward for leadership and management positions in healthcare in general and the NHS in particular. Having made the plunge – I understand why and want to use my insight to support others in following me. My motivation is that I genuinely believe that without active engagement of and leadership by doctors the quality and safety of the service we provide is significantly threatened by the current and ongoing funding crisis. Only doctors have the insight and knowledge that equips them with the skills to make the really hard choices involved in balancing cost and benefit. However to put themselves in a position where they can make those choices in a way that makes a significant difference to large numbers of patients at a scale that also makes a significant difference to the cost of delivering healthcare to the economy requires individuals to make real sacrifices.

My Journey

I am by training an anaesthetist and intensivist. I became a consultant in 2002 and within 2 years found myself clinical director of critical care services in one the of the largest acute trusts in the NHS – operating out of three acute hospitals. This wasn’t because I was ambitious to do so, or even envisaged myself doing that role when I was appointed, it was simply because no one else wanted or was ready to do it (neither was I). My first year as CD I had no directorate manager, I had no training but I did have a fantastic team of senior nurses and consultant colleagues willing to work together as a team. Over the subsequent 5 years I had 6 different directorate managers working with me, some excellent others less so – and therein lies one reason why we should not leave radical reform of services to non-clinicians; only doctors and nurses are in it for the long haul, managers by their nature move on, and don’t always witness the consequences of their actions.

I am lucky to have trained and worked in a truly modern specialty – one that recognises the necessity of team working, that sees doctors, nurses and other healthcare professionals as equal partners in that team delivering an outcome for the patient – one that recognises the need to take control of the whole cycle of care including the pathway to the door of the ICU (through MEWS and critical care outreach) – one that recognises the need to codify and simplify the process of care delivery in order to improve reliability (through care bundles – checklists by another name) – one that recognises the need to measure risk adjusted outcome and use it to continuously improve the service (through ICNARC). Ten years or more of this approach has resulted in an un-sung triumph of healthcare – the virtual elimination of central venous catheter related sepsis, the placing of sepsis in general at the top of the emergency medical agenda, year on year reductions in mortality (our SMR has fallen from 1.3 to a low of 0.73 just before ICNARC re-calibrated the risk model). This is not a unique success, it has been replicated in intensive care units across the country and the world.

I recognised that there are some generalisable principles in the critical care story that if applied across a healthcare economy could bring about radical improvements in the quality of care delivered at the same time as reductions in the cost of care. This belief motivated me to not only learn more about models of healthcare delivery and their practical implementation but also to put myself in a position where I could influence – rather than remain a frustrated observer. It struck me that not only is this an area of fulminant intellectual activity, it is also an area where as an individual one can make more difference to more patients in a shorter space of time than any area of academic medicine (I am after all an archetypal anaesthetist – an impatient physician!).

These thoughts (not necessarily as well formed at the time) led me to apply for the position of associate medical director at my Trust (in 2009), and also to the hallowed halls of Harvard Business School (in 2010/11) where I was exposed to the global cutting edge of thinking in healthcare delivery. This experience has been transformational for me personally, affirmed my belief that this is the right career path for me, and equipped me with knowledge and insights that I am impatient (again) to see put into practice. Many of the ideas will be themes I will draw out in future posts. The time is right – new ideas are becoming established in the thinking of policy makers – integrated care, outcomes frame works, value based competition, improvement science – and the need has never been more urgent.

And so here I am in 2012 about to take up MD post at another large trust. In my next post I will talk about why many wouldn’t do what I have done and why I nearly didn’t…

1 Comment

  1. Hello Dr Roger.
    I met you in Gyn theatre a fortnight ago.Read the post . Very impressive as well as inspiring. i wanted to ask you if there is any way we can have a taster session of way the management actually works?

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