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| Lucia with real candles in her crown! |
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| The Folk Music Group (sounded suspiciously like Irish folk music). The guitarist is the Director of Public Health. |
Wednesday 21 December 2011
December 13, 2011
Wednesday 14 December 2011
December 9, 2011
I met today with staff from Bispebjerg Hospital, one of the main hospitals for the Capital Region of Denmark. The area around the hospital is home for the migrant population and other disadvantaged groups.I first met with the Director for Orthopaedics (and president of the national orthopaedic body) who rose very quickly to a senior role in the Danish Health Board but was required to relinquish his clinical work. After a few years, he realised that he missed this work and returned as Director, where he has been able to mainatin a small amount of subspecialty work. He has a nursing co-director and feels that it's a fairly equal relationship between them. Further to this he described Danish people as 'the most democratic people in the world' who have no hesitation in speaking up to him. His phrase was 'When I ask someone to do something, they don't ask "When?", they ask "Why?"'.
I was interested in his view of the major structural and functional changes in Danish healthcare over the last few years, in particular, the fact that a number of hospitals had been closed. He felt that Danish people and clinicians, in particular, understood that these moves were important to maintain quality and to reduce waste. He said that, as Head of Dept, he has had to find ways to increase productivity for a reduced budget. They have an ALOS of 3 days for joint replacement surgery and have increased productivity by 17% over the last few years. He felt that he had a strong voice in hospital decisions and at Region and national level. This was partly because of his own leadership qualities but also because the structure of the system allowed him clear opportunities. Another interesting thing was that he was asked by the Danish Health Board to provide criteria for referral to specialist orthopaedic clinics for OA - a similar process to our HealthPathways.
I spoke after this with the Medical Director of the hospital. He no longer has any clinical role but he has a very structured approach to involving his clinical directors in decision making in his hospital which includes regular meetings as individuals and as a group. The clinical directors are responsible for the quality and efficiency of their departments and no decision about their departments is made without them present and part of the discussion. The medical Director could not envisage a situation where his clinical leaders would not be part of the decision-making process.
I then had the opportunity to meet the 2 clinical leads for the Dept for Integrated Care - a general physician and a geriatrician who no longer worked clinically. They are trying to work through pathways with their GPs and are working on ways of evaluating any changes they make. They were very interested in the HealthPathways program. To me, their work was the evaluation side to our implementation work so I'm hoping to speak with them again when they're closer to developing their assessment tool.
I was interested in his view of the major structural and functional changes in Danish healthcare over the last few years, in particular, the fact that a number of hospitals had been closed. He felt that Danish people and clinicians, in particular, understood that these moves were important to maintain quality and to reduce waste. He said that, as Head of Dept, he has had to find ways to increase productivity for a reduced budget. They have an ALOS of 3 days for joint replacement surgery and have increased productivity by 17% over the last few years. He felt that he had a strong voice in hospital decisions and at Region and national level. This was partly because of his own leadership qualities but also because the structure of the system allowed him clear opportunities. Another interesting thing was that he was asked by the Danish Health Board to provide criteria for referral to specialist orthopaedic clinics for OA - a similar process to our HealthPathways.
I spoke after this with the Medical Director of the hospital. He no longer has any clinical role but he has a very structured approach to involving his clinical directors in decision making in his hospital which includes regular meetings as individuals and as a group. The clinical directors are responsible for the quality and efficiency of their departments and no decision about their departments is made without them present and part of the discussion. The medical Director could not envisage a situation where his clinical leaders would not be part of the decision-making process.
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| Most staff ride their bicycles to work. |
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| Bispebjerg Hospital, Copenhagen |
Saturday 10 December 2011
December 6, 2011
I had the opportunity to meet with ten senior leaders in the Danish healthcare system for 2 hours. They established a
learning and support network 2 years ago, facilitated professionally. The
network consists of doctors, nurses, a midwife, a physiotherapist, an economist
and a bureaucrat, all of whom had positions of leadership at the region (=state)1 or national level. They meet regularly for an afternoon and dinner and the agenda
may include talks by invited speakers or journal articles that lead on to
further discussion. I was asked to lead a discussion around leadership stories
and what they told us about the way leaders can be developed or supported. While
there are many similarities between Denmark and Australia, some of the many differences I heard were:
1) Union membership is very important to Danish people, including the doctors. The unions have a strong role in determining the quality of involvement and the consensus views that are projected from the clinicians.
2) All hospital leadership teams consist of a doctor, nurse +/- an 'economist' as they were referred to. These leaders do not have any clinical work (or very minimal) - the role of leadership is considered too busy and too vital to allow such indulgences! The medical department leaders and the medical and nursing hospital and regional leaders felt that they were recruited for their specific skills to roles that had very clear responsibilities and accountabilities. Their financial and quality goals are both considered to be vital parts of their roles. The average department (eg anaesthetic dept, orthopaedic dept etc) would consist of around 300 people -doctors, nurses, scientists etc.
3) In one of the 5 Regions of Denmark (the Capital region), the executive and the clinical leadership have decided that leadership training is essential for all clinicians. They had developed 5 different leadership courses which lasted between 10-12 days (5-6 x 2 days) and were tailored to the different roles in the system. I was told that almost 70% of clinicians had been trhough this training so far.
4) I asked about the challenge of leading toward goals that were of benefit to the whole population rather than a department or hospital. They agreed that this has been an ongoing discussion but that they were making headway here. In one specialty, a senior leadership group makes decisions about the adoption of new technologies for the country. This takes into account the cost benefit of the intervention within the limits of the prevailing financial context. They will sometimes make decisions about what interventions should stop being delivered, but agreed that this was very difficult. All of them agreed strongly that Denmark has a limited health budget and that they were tasked with getting the best they could for as many people as possible within the budget.
A little observation - this senior leadership meeting was held in a community owned space, a lovely old building with wooden floors and odd shaped rooms that overlooked a central courtyard through huge windows. The rooms occupied by the group contained colourful, mismatched chairs. In one room was a large old wooden table. In the other, chairs were positioned in a chatty circle. On the narrow shelves around the perimeter of the room, and on little low tables, there were candles and tea lights and big bowls of fruit. It was impossible not to feel relaxed and welcome in this space, and this was evident in the warm, open conversation that ensued.
1) Union membership is very important to Danish people, including the doctors. The unions have a strong role in determining the quality of involvement and the consensus views that are projected from the clinicians.
2) All hospital leadership teams consist of a doctor, nurse +/- an 'economist' as they were referred to. These leaders do not have any clinical work (or very minimal) - the role of leadership is considered too busy and too vital to allow such indulgences! The medical department leaders and the medical and nursing hospital and regional leaders felt that they were recruited for their specific skills to roles that had very clear responsibilities and accountabilities. Their financial and quality goals are both considered to be vital parts of their roles. The average department (eg anaesthetic dept, orthopaedic dept etc) would consist of around 300 people -doctors, nurses, scientists etc.
3) In one of the 5 Regions of Denmark (the Capital region), the executive and the clinical leadership have decided that leadership training is essential for all clinicians. They had developed 5 different leadership courses which lasted between 10-12 days (5-6 x 2 days) and were tailored to the different roles in the system. I was told that almost 70% of clinicians had been trhough this training so far.
4) I asked about the challenge of leading toward goals that were of benefit to the whole population rather than a department or hospital. They agreed that this has been an ongoing discussion but that they were making headway here. In one specialty, a senior leadership group makes decisions about the adoption of new technologies for the country. This takes into account the cost benefit of the intervention within the limits of the prevailing financial context. They will sometimes make decisions about what interventions should stop being delivered, but agreed that this was very difficult. All of them agreed strongly that Denmark has a limited health budget and that they were tasked with getting the best they could for as many people as possible within the budget.
A little observation - this senior leadership meeting was held in a community owned space, a lovely old building with wooden floors and odd shaped rooms that overlooked a central courtyard through huge windows. The rooms occupied by the group contained colourful, mismatched chairs. In one room was a large old wooden table. In the other, chairs were positioned in a chatty circle. On the narrow shelves around the perimeter of the room, and on little low tables, there were candles and tea lights and big bowls of fruit. It was impossible not to feel relaxed and welcome in this space, and this was evident in the warm, open conversation that ensued.
Tuesday 6 December 2011
December 5, 2011
Yesterday, I spent an hour and a
half with Alasdair Henderson, the Chief Executive of the Academy of Royal
Medical Colleges. He is a career bureaucrat who came to the Academy from a
senior role in workforce in the NHS.
The Academy has been around for 25 yrs and is in the process of consolidating its position. Its main roles are as a forum for consensus around issues that are common, or should be common to most of the Medical Colleges, as a voice for doctors in policy development that is separate from that of the British Medical Association and to "promote, facilitate and where appropriate co-ordinate the work of the Medical Royal Colleges and their Faculties for the benefit of patients and healthcare".
Currently, the Academy is contributing to the discussion of the risks and benefits of competition in clinical commissioning and to the need for leadership training for doctors to enhance their ability to contribute to decision-making and leading change. They are also in the process of writing a position statement on the need for consultant presence after hours in addressing safety and quality following a number of high profile incidents.
He made a number of interesting points:
1) The contribution of doctors is underappreciated, in particular the unpaid contribution. Doctors contribute to education, quality improvement and redesign, management and leadership. If they demanded to be paid, the NHS could not afford to pay them.
2) Doctors did not take up the challenge of New Public Management in the 1980s following the Griffith Report and instead retreated into the clinical world. Management was left to managers. In the ensuing 20 years, managers became better educated and expereinced and the gap between the management skills of doctors and managers widened. Doctors now need to address this gap and take a more effective role in leading and managing.
The Academy has been around for 25 yrs and is in the process of consolidating its position. Its main roles are as a forum for consensus around issues that are common, or should be common to most of the Medical Colleges, as a voice for doctors in policy development that is separate from that of the British Medical Association and to "promote, facilitate and where appropriate co-ordinate the work of the Medical Royal Colleges and their Faculties for the benefit of patients and healthcare".
Currently, the Academy is contributing to the discussion of the risks and benefits of competition in clinical commissioning and to the need for leadership training for doctors to enhance their ability to contribute to decision-making and leading change. They are also in the process of writing a position statement on the need for consultant presence after hours in addressing safety and quality following a number of high profile incidents.
He made a number of interesting points:
1) The contribution of doctors is underappreciated, in particular the unpaid contribution. Doctors contribute to education, quality improvement and redesign, management and leadership. If they demanded to be paid, the NHS could not afford to pay them.
2) Doctors did not take up the challenge of New Public Management in the 1980s following the Griffith Report and instead retreated into the clinical world. Management was left to managers. In the ensuing 20 years, managers became better educated and expereinced and the gap between the management skills of doctors and managers widened. Doctors now need to address this gap and take a more effective role in leading and managing.
December 1, 2011
Hello again. I'm on the train back to London. It's 4.30pm and pitch dark
outside!
The GP Commissioning Conference was excellent, with lots of parallels with HealthPathways and loads of lessons for us.
There were many messages, but I think the overwhelming one was that the change from Primary Care Trusts to Commissioning Groups represents a "revolution"in healthcare in the UK. This word was used over and over again along with the exhortation to seize this once in a lifetime chance. The main political players spoke and all were, to me, startlingly deferential to clinicians! The Secretary of State for Health (Minister) Andrew Lansley, said that he had worked hard to hand back control to GPs and other clinicians because he realized that only those delivering care could truly lead the changes that need to occur. Along with the Medical Director of the NHS, Sir Bruce Keogh, Sir David Nicholson, the CE of the NHS and others, he said that the role of the bureaucracy was to support clinicians to lead.
The other strong messages were about localising care for patients and the need to break down traditional barriers. Despite the positivity, there was also a sense of fatigue amongst some who had been working at this for a number of years.
Will elaborate over the next few blogs as I digest all the new information!
The GP Commissioning Conference was excellent, with lots of parallels with HealthPathways and loads of lessons for us.
There were many messages, but I think the overwhelming one was that the change from Primary Care Trusts to Commissioning Groups represents a "revolution"in healthcare in the UK. This word was used over and over again along with the exhortation to seize this once in a lifetime chance. The main political players spoke and all were, to me, startlingly deferential to clinicians! The Secretary of State for Health (Minister) Andrew Lansley, said that he had worked hard to hand back control to GPs and other clinicians because he realized that only those delivering care could truly lead the changes that need to occur. Along with the Medical Director of the NHS, Sir Bruce Keogh, Sir David Nicholson, the CE of the NHS and others, he said that the role of the bureaucracy was to support clinicians to lead.
The other strong messages were about localising care for patients and the need to break down traditional barriers. Despite the positivity, there was also a sense of fatigue amongst some who had been working at this for a number of years.
Will elaborate over the next few blogs as I digest all the new information!
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