Merging the Medical Microbiology Oncall in a Newly

Merging the Medical Microbiology On-call in a Newly Formed Trust • Susie Jerwood, Consultant Microbiologist, St Richard’s Hospital, Western Sussex Hospitals NHS Trust Case study: This is a more detailed examination on how I changed to physician-led interpretation of gentamicin on the SRH site BACKGROUND Western Sussex Hospitals NHS trust was formed in April 2009 by the merger of the Royal West Sussex NHS trust and the Worthing and Southlands NHS trust. There are five consultant microbiologists in total with two at the St Richard’s hospital site (SRH) and three based in Worthing but also covering Southlands hospital (WASH). This was one of the biggest challenges as merging the on-call could not go ahead without it being changed. METHODS • Work out what we were hoping to achieve – Begin with the end in mind • Establish what the obstacles were – try to create a win-win scenario Background There was lots of resistance to changing the method of interpretation. This was due to people being wary of using a new method and worry that they wouldn’t manage. The key was raising awareness of what was wrong with the current system and what could be improved. This led on to interest, in particular from the juniors who were the most likely to see the difference. • Involve all the stakeholders – Circle of influence/concern • Implement the changes – 7 stages of change management Method The handover was split into sections: • Audit of current practice so we knew what was happening prior to the change The on-call has always been carried out independently on each site but recently there has been discussion about merging the on-call so that one consultant would cover all three hospitals on a 1: 5 basis • Intense advertising and educational campaign • Re-audit after switch over Obstacles • Offer of additional support with “open-access” tutorials Outcome The re-audit is still in progress but having looked at all the data for the first week there was not one mistake due to the switchover. In fact, possibly due to the educational campaign, the request forms were filled out better than previously. PERCEIVED BENEFITS Current plan is to: Laboratory differences Gentamicin interpretation Differences in BMS on-call 1. Complete the audit 2. Assess whethere any safety issues and if so address them 3. Offer regular teaching and support for the clinicians See text box • Personal • Time might be freed up for other clinical commitments • Better cover CONSULTANTS • Rota more robust • Opportunity to improve on-call • Opportunity to move other aspects of merger forward Weekend reading of blood cultures Evening handling of blood cultures SUMMARY Plans to change on SRH site to same on WASH have implications on BMS staff and are therefore taking longer to implement Management changed on SRH site to be compatible with that on WASH Substantial differences in pay and work load out of hours need to be aligned before the BMS on-call can be merged. TRUST and other users Job planning • Time spent on-call will be much busier • Will there be job plan implications? • Will different working practices cause difficulties? • Are there any cost implications? • Will the same quality of on-call be delivered? Following the merger there were great expectations that the departments would seamlessly merge. By merging the consultant on-call it was perceived that everyone would benefit: • Cost savings for the trust • Improvement in working conditions for the consultants There have been many challenges during this project which can be separated into 3 areas: 1. Getting everyone on-board 2. Sorting out the real problems from the perceived ones Differences in pay banding We are currently paid differently for our on-call on each site. The main difference is that on the WASH site they are paid at a lower rate on the understanding they don’t have to be immediately available. Neither site wants to change so negotiations are still under way. Time in lieu Working less hours will result in less time in lieu. How will this impact on our working week? 3. Tackling the real problems quickly and efficiently 4. Without the course I don’t think I would have known where to start and I certainly would have struggled with dealing with some of the issues – mainly those created by obstructive personalities. As it is there is still some work to do. The obstructions have not all proved easy to remove and in order to maintain working relationships it has been necessary to slow the process down. 5. The merging of the on-call will still go ahead. PERCEIVED CONCERNS

The Leadership Path • Susie Jerwood, Consultant Microbiologist, St Richard’s Hospital, Western Sussex Hospitals NHS Trust Influencing the future: A leadership programme for Pathologists in the NHS South East Coast This is a programme that was set up following a successful pilot. The programme aim was: “To develop a group of senior pathology healthcare scientists, equipping them with a greater understanding of the issues faced by high-level leaders and some of the essential skills required to consolidate and expand their leadership roles during their career pathway. ” This poster shows the highlights of the journey I have taken, along with examples of where I have found the skills most useful. I have chosen the analogy of signposts as what I’ve learnt is guidance on reaching a destination rather than the end goal. The text box on the right shows the non-modular parts of the course which ran along side the main content. I have also included what I found to be “light bulb” moments as denoted by “ “ PACE group LQF A way to find out others’ perceptions of you in an unthreatening manner What did I learn? I’m generally approachable I can come across as over-confident I usually scored myself lower than my raters did so perhaps should be more confident? ? How it helped me Support – for ideas I had Ideas – when running short Encouragement – for difficult tasks Leadership Impact Survey Coaching sessions 1: 1 sessions exploring the aspects of leadership that particularly affect me day to day How they helped me Helped me focus on what was important Put plans in perspective Aided the decision making process Time management Time should be considered as a physical space, ie with hard edges which can’t be squeezed Sand tennis ball analogy The group met 4 times over the course. Initial discussions were based on problems individuals were having at work. Later sessions focussed on projects Primary impact – Challenge Led (Results-Driven Space) Secondary Impact – Support Led (Confident Space) What this means to me I am at low risk of “burn-out” or “rustout” Paying greater attention to my emotional reactions may provide important insights to help manage responses Emotional intelligence Identify your own emotions and be responsible for your own feelings. How this has changed my practice? I have turned the bleep off my emails so I don’t get distracted and check them as soon as they come through How has this changed my practice? This has made me more aware of how my own feelings can bias an interaction Personality types One of the most enlightening sessions. Amazing to be able to work out why some people behave as they do. How has this changed my practice? I have already managed to change my manner towards some people as I recognise they may respond better to being treated differently. Listening on 3 levels This is theory behind the common sense that people don’t always say what they mean When has this been used? Covey’s 7 Habits Noticing a bad habit is the first step to changing Sharpen the saw – becoming more effective will save time in the end How this has changed my practice? By reflecting on what I want to achieve before starting I’ve found it easier to reach my goal This has been very useful during my project to try to establish why things haven’t moved forward despite apparent agreement with all parties. Decision Tree Use to assess how much responsibility you can give someone. When has this been used? This is a useful check when making decisions. I don’t discuss it but use it as a gauge to maintain consistency. Coaching behaviours Ask 3 questions before offering advice How has this changed my practice? Slowly this is becoming a habit – both in- and outside of work. Frequently people have an idea of the solution even if it is not fully thought through and appreciate the opportunity to give it.