Leadership Questions Flashcards
What is situational awareness?
Is being aware of your surrounding and being able to respond quickly to prevent mistakes
Good example of situational awareness
When in theatre
you need to be aware of what your registrar or consultant are telling you, what stage of the operation you are at, the duration of the operation, the observations on the anaesthetic monitoring, the doors of the theatre being shut, the position anyone nearby to avoid break of sterility
For example, I was assisting with a difficult IM nail and the bipolar and suction were loosely placed on the patient, I asked for a clip to secure it in order to avoid loss of equipment and potential patient safety compromise
Should doctors be educators
Education is key as doctors, we have a workforce crisis with an ever-increasing demand on the NHS, we need to train juniors to ensure sustainability. Plus the lack of opportunities due to the pandemic means that doctors to be good educators, or we will end of with a worse workforce problem than already predicted.
I am currently doing a teaching job where I have developed my teaching skills greatly. Through doing PG cert I have come to appreciate the importance of setting up a good learning environment, clarifying learning outcomes and including a range of activities as means of enhancing the quality of the teaching.
For example, no matter how good the content, if teaching in poorly lit room just after lunch, the juniors less likely to learn
Tell me about a challenge you’ve faced as a leader and how you have overcome it
Situation: When I started delegating tasks as a part of my organisation, tasks were coming back to me incomplete, late or completely different from what I was expected. This made both me and members of the team frustrated
On reflecting on this, I realised it was my communication that was the main issue:
- Used closed loop communication
- I included more specific instructions, a deadline
- gave opportunities to ask questions
- also if it was a more complicated task, or something completely new, I communicated this through a phone call or a video call
This led to a much better team environment where everyone knew exactly what was being asked of them
WHO checklist
It was introduced in 2008 to improve safety of surgery and prevent never events
WHO surgical checklist
Sign in: before induction of anaesthesia
Time out: before skin incision
Sign out: after op before patient leaving the theatre
Sign in Qs
Identity Consent form Site of op ?marked Name of Procedure Estimated blood loss
Time out components
Members introduction Name of pt and procedure ?special equipment Abx prophylaxis Diabetic control Hair removal
Sign out Qs
Instruments swabs and needles counted
Faulty equipment reported
Specimens sent
Recovery concerns
What is a clinical audit
A systematic review of how well an organisation is doing a certain procedure compared to a pre-set standard such as NICE guidelines
What is clinical governance def
- Quality assurance process
- ensuring standards of care are maintained and improved
- ensuring that NHS is accountable to the public
What are 7 pillars of clinical governance
PIRATES
Patient and public involvement (patient feedback questionnaires, PALS, patient forums)
Information and IT
Risk Mx (guidelines/protocols/M&M meeting to minimise risk to pt/staff)
Audit
Training and Education
Effectiveness and research (evidence based, research, NICE guideline implementation)
Staff management (staff retention by motivating/developing them, good working conditions)
Main 4: CARE Clinical effectiveness Audit Risk management Education and training
4 main ethical principles
Beneficence - act in best interest
Non-maleficence - do no harm
Autonomy - right to choose
Justice - must be treated fairly: distribution of scarce resources
What makes a good core surgical trainee
Good at prioritising
Knows limits, when to escalate
Organised, gets tasks done efficiently to get more experience on the wards
Team player: works well with the juniors and seniors
Good communication example
STAR:
Situation: attending a cardiac arrest.
Task: Performing CPR
Action: clearly explaining when we should change, counting us in, commenting on our depth/quality of compressions.
Reflect: I think this was a great example of leadership. A good use of closed loop communication, as well as saying out loud at what stage we were, so we had ruled out several causes for this patient’s cardiac arrest and what were going to do next. Kept everyone motivated as were aware of what was happening and what was going to happen next
Bad communication example
STAR:
Situation: consultant prioritised one of their private patients over the NHS patients without informing the juniors of the reasoning.
Task: This put the team in a difficult position when providing care for this patient as one contradicting one of the four ethical principles: justice: making sure fair distribution of resources amongst the patients.
Action: However, I explored this with the consultant and clarified that the private patient’s operation was expedited due to their deteriorating health.
Reflect: I think this was a failure of leadership. A good leader will predict this potential conflict of interest issue and inform the team of the reasoning behind the decision making.
Good culture of team building and motivating
Situation: Low moral as understaffed and redeployment
Task: SpR met one on one with all of the juniors to explore our concerns and suggest solutions where possible. Also was bringing snacks for everyone, creating a friendly team environment. Lastly made herself more available on the wards so all the issues were addressed with early senior support
Reflect: On reflecting on this, this registrar was demonestraing qualities of a great leader, recognising there was a problem within the team and coming up with stragies to address it, boosting moral and motivating everyone to keep going.
Bad culture of improvement
Situation: a patient safety issue was discussed in the M&M meeting,
Task: instead of coming up with solutions to avoid in the future, one of the consultants was very keen to find out who was responsible for the mistake, making the team spend 10 mins trying to find out using the notes
Initiave: the junior involved had already had multiple incidents regarding this and the issue was considered solved, however the blame culture led to embarrassment of the junior
Reflect: on reflecting, there is a reason to find out who made a mistake to ensure they receive the support/training needed to avoid in the future, but doing this in front of everyone and not acknowledging that actually multiple things went wrong and it was the Swiss Cheese model that led to this and not a single failure was failure of leadership. As this led to lowering of the team moral.
Good teamwork
We realised when splitting the ward round, everytime one specific consultant was on, the ward round would run really late, meaning the junior will finish the ward round late and need to stay to complete the jobs.
We decided to have a shared jobs list when that consultant was on, meaning that everyone would help to finish all the jobs before going home. This helped create a much more friendly environment and boosted moral.
Examples of never events
Surgery on the wrong site Procedure on the wrong patient Long blood type transfusion Foreign body left in patient post op Severe Pressure ulcers acquired in hospital
What is the definition of never events
An event that is completely preventable, and could lead to serious harm to patient
Example of audit that you were involved with?
Under the supervision of one of the orthopaedic consultants, I led a retrospective audit of IM nails performed over one year period looking to see if certain standards such as Tip Apex Distance (TAD) of less than 25mm were met on the post-op films this standard was taken from a Baumgaertner 1997.
We presented these findings at an M&M meeting and collected another set of retrospective data to see if this had improved things.
We then repeated the measurements to see if our intervention: improved from 5 out of 89 to 2 out of 90
Example of QIP that you would have done
I have led on QIP project completing 3 PDSA cycles, presenting the findings to the quality improvement team.
Improving the weekend handovers ensuring they included specific details such as what day, specific task and what grade should be
At first, only 38% of the handovers included all that information
However, over the course of the year and by putting up 3 interventions, this increased to 93% improving patient safety
Presented to the hospital improvement team who started work on incorporating the template into the hospital systems.
QIP definition
improving services to enhance patient experience or safety
Uses a PDSA cycle of plan
