Scenario 2

Question 1

Overview/Intro

Answer 1

Challenges can be divided into: patient safety concerns, team work, own training and wellbeing.
* Common scenario in working in the NHS
* Take into account:
* * * GMC guidance on duties of a doctor/raising concerns
* * * Local trust policies
* * * 7 pillars of clinical governance.

Question 2

Patient safety

Answer 2

o Patient safety concerns the first priority to address.
o Are there immediate risks (e.g. insufficient staffing for 1:1)
 Escalate to clinical supervisor –> clinical lead –> clinical director –> medical director.
 Escalate to nurse in charge, ward manager, matron or unit coordinator (e.g. may be able to find immediate solutions like redistributing staff).
 Consider speaking to freedom to speak up guardian for advice if needed.
o Assessing for risks - encourage culture of transparency/learning not blame
 Use datix and incident reporting.
 Can consider a risk register to highlight patterns.
 Get service user feedback.
 Discuss with colleagues/MDT to solicit feedback - consider an external facilitator.
 Audit if risks in a specific area.
o Solutions:
 QIP to improve efficiency or reduce error risks.
 Audit intervention - guidelines exist
 Staff training

Question 3

Personal impact

Answer 3

o Training Impact
 May be difficult to find time for curriculum objectives/PDP/ supervision.
 Might be stretched beyond limits of clinical competence.
* Solutions:
o Use supervision to ensure appropriate PDP and schedule how/when goals will be met, consider timetabling WPBAS.
o If insufficient could escalate to ES, TPD and even director of medical education.
o Maintain protected time boundaries
o Utilise study leave appropriately
o Report via exception reporting, raise with guardian of safe working hours.
o Opportunities to develop e.g. in QI projects, management/leadership experience
o Wellbeing Impact
* o Important to monitor own wellbeing.
* o Raise concerns with supervisors, OH or work counselling if needed.
* o Maintain work/life balance, relaxing activities and supportive relationships outside.

Question 4

Team and colleagues impact

Answer 4

o Likely what is impacting me will be affecting others too, safety and wellbeing of team is at stake. Can lead to breakdowns in morale, communication and a vicious spiral of absences/vacancies increasing pressure more.
o Would be good to discuss with team manager/consultant and arrange a staff meeting to share concerns and come up with solutions.
 Could bring in an external facilitator like a counselling psychologist from OH to encourage free discussion.
 Discuss with other trainees
 Potential systemic solutions/QI ideas include
* Morning safety huddle daily
* RAG ratings for patients so new staff can see risk levels
* Better workflows in terms of common tasks e.g. letter templates/delegation
 Raising morale
* Staff training and education
* Social events and away days
o Consider impact on future trainees
 Handover to them concerns and QI projects started
 Raise with TPD
 Raise in trainee surveys
o Support my juniors
 Invite them to freely ask for advice and raise concerns with me
 Make sure they get breaks and lunches
 Facilitate learning opportunities e.g. leading ward round.

Question 5

Q1 - What is your responsibility in this situation?

Answer 5

o Patient safety first
o Then team/colleagues
o Own training and wellbeing needs

Question 6

Q2 - How should you approach working with colleagues in this situations?

Answer 6

o What is impacting me will be affecting others too, safety and wellbeing of team is at stake.
o Chronic stress may lead to poor communication, loss of morale. Increased absence and sickness.
o Demonstrate good communication skills, being a team player, leading by example all important to maintain relationships and goodwill.
o Facilitate psychological safety - I would want to be seen as a source of support and encourage colleagues to be able to raise concerns with me without fear of consequences - a culture of transparency and accountability starts with individuals.
 Similarly would discuss my concerns with other trainees. Consider raising concerns with reps, organise discussions at junior/senior meetings, organise a survey.
o Would be good to discuss with team manager/consultant and arrange a staff meeting to share concerns and come up with solutions.
 Could bring in an external facilitator like a counselling psychologist from OH to encourage free discussion.
o Important to have buy in from staff for any QI projects/changes to ways of working. Sense of shared ownership.
o Try to maintain positive and solution focused orientation to the issues.
o Build morale with away days, awards and recognition.
o Teaching of colleagues to build confidence.
o Support my juniors so they had breaks, felt they could discuss things with me, got learning opportunities.

Question 7

Q3 - What skills are critical in managing this situation and how would you use them?

Answer 7

o Communication skills
o Identifying and solving problems – e.g. where are the sticking points (personal experience or soliciting from colleagues), how might they be addressed e.g. QI ideas
o Leadership – leading by example, taking initiative
o Time management – staying organised and prioritising when overstretched
o Coping with stress

Question 8

Q4 - What approaches could you use to keep your training on track?

Answer 8

o May be difficult to find time for protected learning, curriculum objectives/PDP and supervision.
 Solutions:
* Discuss in supervision to make sure getting time for learning opportunities, have a PDP and ways of achieving them and WBPAs on track.
* Maintain boundaries with protected times.
* If insufficient could escalate to ES, TPD and even director of medical education.
* Seek learning opportunities elsewhere.
* Report working overtime via exception reporting, raise with guardian of safe working hours.
* Use situation to gain training opportunities e.g. QI projects, audit
* Reflective practice and use of portfolio.

Question 9

Q5 - What mechanisms could you use to improve the training environment for you and later trainees?

Answer 9

o Do QI work to improve the workload/environment
o Discuss with clinical supervisor/educational supervisor/TPD/Director of medical education
o Raise concerns at junior senior meetings
o Raise concerns in training surveys
o Exception report/raise consistent issues with guardian of safe working hours.
o Handover to next trainees concerns and QI projects started

Question 10

Q6 - How might this impact your chosen specialty

Answer 10

o Long term burnout may lead to a vicious cycle of understaffing and poorer care –> ultimately lead to patient harm –> negative public perceptions, loss of patient confidence.

Question 11

Q7 - What are the 7 pillars of clinical governance?

Answer 11

o Patient and public involvement
o Audit
o Risk management
o Training and Education
o Information management
o Effectiveness
o Staff management