Teamwork and leadership in the NHS

Teamwork and leadership skills are very important when you work in the NHS.
As international medical graduates, we are not used to applying these terms when we are working in our home countries. However with time and experience in the NHS, we realize how important these are.

I have discussed this in the form of frequently asked questions.

Why is this so important?
Working in hospitals is not only about application of medical knowledge. It is about managing patients together for their betterment. Here are a few examples:
1. Liaising with other members of the team like occupational, physiotherapists and discharge coordinators ensuring safe discharge of patients.
2. Involving other specialties for management of complex cases. Like involvement of the medical oncology team, cancer specialist nurses, specialty specific MDT discussions for management of a patient with newly diagnosed cancer.
3. Involvement of renal pyschologists, renal transplant surgeons, renal dieticians, renal pharmacists, renal specialist nurses in the management of newly diagnosed end stage renal disease.

But this is all specialty work which will not be expected from me as a SHO.
You may be involved in these even as a SHO if you are working in these particular specialties and may be asked to talk to other members of the MDT.

As a SHO you may be expected to do the following:

1. Help your colleagues actively
For example, if you are the on call SHO and are clerking but the list is not busy and your colleagues are very busy on the ward, you should actively help them out. If you ask them if they need help, they may say that they are fine. However you need to encourage them to share their workload.
Ask your colleagues if they have had a break - if they have not, ask them to give their next task to you and allow them to go to the doctors mess.
When on call, give your phone number to the FY1s - Let them know that they should contact you immediately if they are stuck at any point.

2. Help your team 
When you are clerking, you can help delegate tasks. If you are on call and are clerking direct admissions from GPs, request the nurse to do bloods, cannulas and VBG if (s)he is not too busy. Keep checking the patients list and see if there are any GP referrals here so that you can request the appropriate investigations immediately.

3. Teach medical students and use their skills
There are loads of medical students not only in teaching hospitals but also district hospitals. You may also find clinical observers and physician associate students. Use their skills and help them develop their skills. If they are allowed to, ask them to do cannulas, bloods, ECGs, catheters, document your ward round and at the same time explain which patient you are seeing, explain which medications they are on and why they are on it.
This way, your tasks will be divided as well and they will learn. A win win situation for all.

4. Recognizing problems and solving them. 
Your colleagues may be struggling. You may see a SHO really upset. It happens all the time. It is very important that we support them in times of stress. Talk to them. Ask them what is bothering them. They will open up. Try to help them by solving their issues. Common problems which doctors may face are mentioned here:
Common problems IMGs face- with solutions
http://omarsguidelines.blogspot.co.uk/2017/10/common-problems-imgs-face-with-solutions.html
There might be other issues - simple issues like no proper handovers on the ward between doctors and nurses, no proper handovers between ward teams and on call teams, etc. You can solve these by doing a QIP as I have explained here:
http://omarsguidelines.blogspot.com/2018/02/all-about-quality-improvement-projects.html

Why are leadership skills so important?

When you are a registrar, you will be:
1. In charge of the on call team - you will have to delegate tasks, escalate patients to the appropriate seniors, liaise with other specialties to transfer patients to the appropriate teams , ensure that your junior doctors have rested well and are not overworked, talk to bed managers to ensure safe discharge of possibly fit patients by liaising with the on call OTs and PTs. Leading CRASH calls and leading peri-arrest calls. Managing unwell patients together with the ED team when they come into the hospital. 
2. On your specialty ward- Do ward rounds when the consultants are not available. Discuss appropriate patients with the consultants, ensuring your juniors complete their jobs but are not overworked, do a thorough handover of patients to the nursing staff. 
3. Do QIPs. In summary, being able to recognize a problem, being able to measure it and then bring changes and then being able to measure the change. You may have to involve your junior colleagues as you may be very busy to do everything on your own and hence have to be able to delegate tasks appropriately. 
4. Do clinics - Make a reasonable follow up plan with patients, request appropriate investigations, confirm the plan with your consultant if you are not sure ( thus being able to know how to approach him/her during a busy clinic). 

As a consultant 
All of the above PLUS you will also be chairing a lot of meetings, working on improving the services of your hospital and making sure all members of your team are well looked after. Also read this:
https://omarsguidelines.blogspot.com/2018/12/the-life-of-consultant-in-nhs.html

If you are not a good leader, your team will not run smoothly. When this happens, mistakes happen. And when mistakes in medical practice happen, patients suffer and it everything falls apart. Doctors are referred to the GMC, complaints are made against them, their supervisors get negative feedback about them making it difficult for them to pass their ARCP/appraisals. 

This seems so difficult! 
It sounds difficult, but if you start developing your leadership skills from and early stage, you can easily manage all of this. 

So the bottomline is, 
Do not be shy. Try to develop your leadership skills. Yes, clinical knowledge is very important however leadership skills are equally important when it comes to working in the NHS - the earlier to start working on this, the more settled you will feel when you progress to a more senior role in your career. 

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