Interview Questions Flashcards
Why do you want the job?
Great department, great hospital, right moment in my career.
Feel I have a lot to offer - management style collaborative, lean processes.
Department needs good positive, clear leadership right now and I love a job that needs doing.
Why me?
Personal attributes - inclusive and collaborative but get projects over the line
Credibility - clinically and track record of getting things done
Processes - appreciate lean processes and the way they improve staff and patient wellbeing and save money too.
Main challenges for the ED?
Winter and coronoavirus combining to put the hospital under extreme pressure - particularly felt by ED nurses
Ever expanding footprint stretching staff resources thinner
Budget challenges once we are through the worst
Training and research etc hard to maintain
How do you improve morale?
- Acknowledge difficulties
- Include staff in working out how we are going to improve things
- Stop doing things that add little value
- Focus on what makes a difference
- Gratitude
What happens if ED attendances return to normal before exit block gets better?
- Numbers are low with minors patients mainly - extending divert to MIUs may be asked for
- Vanguard will help
- Some streamlining of triage processes possible?
- New single clerking frees up some capacity to share medical single clerking work
Plans for the next 3 years?
- ED and AMU working better together
- An ED that is really buzzing and plugged in to the rest of the hospital and the region.
- Working groups making incremental progress in a way that builds an excellent service e.g. education,
- Establish KPIs that are meaningful in house and that everyone in the department is clear on what they are.
Finance
Lean processes improve patient care and reduce duplication and waste and this saves money
Patient experience
We get a lot more compliments than complaints. People are very forgiving.
Long waits for minors
The state of people when they leave - hard to shower or wash clothes
Information to follow up their own referrals e.g. to urology stone clinic or first fit clinic
Patient Safety
Freed up time for medical juniors to follow up outliers in ED more closely - 2nd doses antibiotics etc
Consultant meeting replaced by CG once a month
Training, education, checklists
Ambulance Offload
Covid challenge
Safety and dignity challenge
Passing on delays to prehospital patients to be avoided if at all possible
No absolute rules but an absolute last resort - we should be able to manage in all but the most exceptional circumstances
Patient FIRST
Flow Infection control Reduced Patients in the ED Staffing Treatment in the ED
FMLM - Creating resilience
- Leeds clinical lead reflections
- Chimp paradox
- Helen Bevan - change management
NSW Leadership Modules
Data and good systems
80:20 rule
Effective uses of management tools
Practical steps for iterative change
ED and AMU co-working
Not enough of this! Sibling rivalry = counter productive Cluster can work a bit closer together Reduce duplication of work IT improvements Happier AMU = happier ED. ‘Happy spouse, happy house’
CQC Plan?
Safe Effective Caring Responsive to people’s needs Well led - strategy, governance, culture, seek and act on feedback, continuous improvement.
111 - cooperating with the wider health system
Better options for patients
Right place first time
Probably won’t reduce attendances overall but may mean more appropriate patients attend each service
Consultant Expansion
Increased resources e.g. for weekend cover and locum savings offset
Managerial / leadership / safety benefit
Extra supervision required of junior docs than used to be acceptable, also ACPs, students etc
Balance cost vs improvement
We’re a lot closer than we were to where we need to be
4 Hour Target
NBT approx 78% (so is the 2 month target for GP referral to definitive treatment for cancer)
Still important - everyone gets it, it is a marker of safety and quality
Not the only way to tell the story e.g. DTA times, patient density, APD
?Could discharge more with a 6 our target (or would this just lead to more exit block)
Early transfer work
UECOG
Informs the BNSSG ICS
Published as part of Healthier Together on a more simplified, integrated system with better use of options other than the ED.
e.g. Pharmacies, developing NIUs to UTCs, other SDEC providers
BNSSG Reforms = Building an Integrated Care System (ICS)
Primary Care Networks (PCNs) - groups of practices working together
Social prescribing
UHB and Weston merger to UHBW
Improving Access to Psychological Therapies (IAPT)
Integrated Urgent Care Service - links 111 with out of hours GP services
Integrated Care Bureau - helping facilitate earlier hospital discharges
LeDeR - learning difficulties review
“Healthier Together” - the BNSSG STP (Sustainability and Transformation Partnership) is now on the next stage and is an Integrated Care System (ICS)
Debt! £120m. Spend £1.5bn and £35m over last year = 2.3%. Aim next year <1%
Half money on acute hospitals, half on community and mental health
111 - takes >300,000 calls a year in our area
“North Bristol Trust has successfully introduced comprehensive clinical streaming at the front door of the A&E department.” - JC work made it into the BNSSG CCG 19-20 Annual Report!
My Strengths
- collaborative approach
- clear eye for lean processes
- ability to get projects over the line
- persistence and stamina
- love data and spreadsheets
- very ambitious for the department
My Weaknesses
- perceived as more radical than I am!
- not overly keen on being filmed for TV
- not always ambitious enough personally? (should have applied last time?)
Strong Leadership
Resuscification of Majors Project
- clear vision and rationale for a process change to make the department safer and more efficient
- Consultants, registrars, Band 6 away days, band 7 away days
- taking feedback and listening to concerns and working out how to mitigate problems
- flexibility to maximise chances of achieving the aim in a different way is very different to flexibility which allows undermining of the aim and lack of progress
Pareto Principle
The 80:20 rule
You can achieve 80% of perfect in 20% of the time and resources it takes to achieve perfect
Projects I’m happy to talk about
Resuscification of majors Ambulatory ED - Majors Chairs Urology guideline Cmac Airvo Severe Sepsis 4pm H&S with predicted patients and a plan made in daylight Single Assessment for Medical Patients - in progress!
What Four Words?
Collaborative
Effective
Encouraging
Strategic
Trust Values
- Working well together
- Putting the patient first
- Recognising the person
- Striving for excellence
