Our managing director Jane Braithwaite explores the broad subject of managing people and teams, covering topics such as our responsibility as employers, leadership styles, different employment models and well-being.
In this issue, she recommends the three ‘C’s – clarity, communication and care – for improving the power of your people and managing your team through this difficult period.
It is the people within them that make companies and businesses work, and this is especially true in healthcare. Despite huge advances in technology, including the automation of many administrative processes such as the incorporation of robotic surgery and the use of artificial intelligence in diagnosis, it is still fundamental in all healthcare businesses to have the right people, with the right skills and attitude in the right roles. There are very few examples of services or businesses where one person can do everything and, in most cases, it takes a team effort.
Sense of achievement
If you are a surgeon, for example, there may be moments where you feel you are alone, but caring for your patients is a communal effort and requires the commitment and dedication of a group of people with varied skillsets working together.
A well-performing team is a joy and being part of such a team is fulfilling on many levels: the sense of achievement and belonging, the feeling of being respected and of making a valued personal contribution. But for every high-performing team, there is an opposite, less successful example. Most of us have experienced at least one team in our career that is verging on dysfunctional.
Prior to the Covid-19 pandemic, we were already aware that, in the UK, people were feeling under pressure and struggling to maintain a healthy work-life balance. Of greatest concern in this current climate is the increased pressure that people are experiencing in both their personal and professional lives. Everyone is attempting to handle the uncertainty of Covid, coping with the lack of control, worries about their health, finances and the health of their friends, families and colleagues.
Relying on adrenaline
In a crisis, we rely on adrenaline to help us perform and, in most cases, the crisis is short-lived and this short-term solution is appropriate. To continue to rely on adrenaline on a long-term basis is potentially damaging and we expect this to cause numerous longer-term issues.
In the early days and weeks of the pandemic, business owners, including those in private healthcare, focused on survival. What do we need to do to get through this? At the time, there was a sense that this would last for weeks rather than months.
The Government announced measures to support employers in the form of the job retention scheme alongside various loans and grants, to support us in achieving the goal of survival. Many individuals were furloughed from their positions and some continue to be furloughed at the time of writing due to a further extension of the policy. While being furloughed may sound like a pretty good deal, many have suffered from increased stress due to job insecurity and anxieties related to financial and career impacts. In the worst-case scenarios, we have seen an increasing number of people being made redundant and there is an expectation this will continue as the Government schemes eventually come to an end.
For those individuals who have worked throughout the pandemic, we are seeing signs of burn-out.
Tension between colleagues
However, one unanticipated symptom of furlough is a tension between work colleagues where those who have continued to work perceive their furloughed colleagues to have had the easy option, leading to an underlying resentment. Many of us have been adapting to working from home either on a part-time or full-time basis and this brings about a new set of challenges. Initially, it was the logistical issues of home-working that focused our attention. Setting up secure IT systems, adapting to working in a paperless manner, talking to one another via Zoom and so on. As the weeks and months have passed, our focus has shifted to the reality of working remotely long-term, managing teams of remote workers and ensuring everyone remains motivated and productive.
Bringing staff back
Clinics and offices have faced the challenge of bringing their employees back in a Covid-safe manner and adapting the physical environment to ensure it is safe and compliant. Space limitations have reduced the number of people who can physically be in the workplace on any particular day, leaving members of staff continuing to work at home on a part- or full-time basis. Some people have been reluctant to return to the office, either because they love working from home or they are scared to come back, particularly if their commute involves public transport. The current crisis looks set to continue for some time and, as leaders and managers in healthcare, we need to take action to address these issues and support the people that make up our teams so that they continue to be high performing. With that in mind, how do we create high-performing teams in this current climate? It is a challenge!
This month, my initial recommendations for improving the power of your people and managing your team through this difficult period are clarity, communication and care.
Clarity helps to alleviate a lack of control and improving clarity may help many people to deal with the current environment. Many of us may feel that we need to regroup and rebuild, and we are faced with the challenge of doing this in difficult circumstances, as the immediate future is not totally clear to us. In times of uncertainty like this, it is often valuable to go back to basics and consider the way in which we manage people, to review our responsibilities as employers and improve our policies and processes from a people perspective.
We adapted our workplaces very quickly to allow our organisations to continue to operate and survive the crisis. Our teams accepted this and changed quickly too, but, in our haste, we may have lost some clarity regarding roles and responsibilities. We need to reconnect with our teams to understand how the changes have affected them, how they are feeling about these changes, what is working well now and what needs addressing. Ensuring that everybody has clarity on their individual responsibilities and how their role impacts on others within the team will enhance both individual and team performance. A positive way to do this is to review each team member’s objectives so they have absolute clarity of what is expected of them in the short term, the next month and quarter.
Good leaders communicate with their teams, both individually and together, on a regular basis. If in doubt, over-communicate. In a time of crisis, we all need reassurance, and communication is vital to provide this reassurance. Ensuring everyone is aware of the current situation and what changes are happening is important, even at times when we are not entirely sure ourselves. Many people are interacting less with work colleagues as well as in their personal lives and this can lead to feelings of isolation.
If your team is working remotely, communication is even more important. You can communicate in a variety of ways including emails, video and phone calls. Not all communication needs to be formal and you may want to recreate the office atmosphere by agreeing a regular, perhaps weekly, opportunity for a general chit chat over a cup of tea.
Caring for our teams and providing additional support will pay dividends in the short and long term. The topic of mental health is being discussed more openly than ever and appropriately so, given the number of individuals in the UK who are suffering from some form of mental health problem. Again, we were aware that this was a big issue prior to Covid, but this has exacerbated the situation in a big way. Absence from work due to mental health has increased over the last few years, which has led to mental health becoming a boardroom discussion, as it impacts on the productivity of an organisation. As employers, we have a ‘duty of care’ and a responsibility to do all we reasonably can to support our employees’ health, safety and well-being.
If a member of our team has a mental health issue, we need to talk to them to determine what support they might need. If an employee feels they are well supported, the issue is less likely to build up, which results in less time off, improved morale and greater loyalty.
Creating a culture where mental health can be talked about as openly as physical health will allow individuals to raise their concerns and worries before they become significant.
You could consider running an employee survey, asking specific questions relating to well-being and mental health and collecting responses in an anonymous way to give you a true picture of how your team are feeling. Having one-to-one discussions with each employee allows an opportunity for personal issues to be raised and discussed in a safe environment. Consider creating a mental health or well-being champion for your organisation or making mental health training available. Leaders who address well-being and mental health will allow their team to succeed and will also benefit from greater loyalty on a long-term basis.
Article written by Robin Stride and originally published on Independent Practitioner Today, 8th December 2020
Private doctors are being advised today to rethink their marketing to cater for people who have delayed getting medical help due to Covid-19 fears.
Worries about contracting the virus have made as many as 29% of people avoid seeing a doctor or going to hospital despite having a known medical condition, according to results of research this week.
Zegami, an Oxford-based medical image analysis platform, says its research reveals that as many as 254,000 people with cancer may have avoided seeking help. Zegami has recently developed a system to analyse large numbers of mammograms and identify abnormalities
It also found that 16% of people believe they have developed a medical condition since the Coronavirus crisis started but decided not to see a doctor.
Again, this was because of fears about Covid-19. Some 101,000 people believe their condition could be cancer, it believes.
A private practice marketing expert called the figures ‘terrible’ and told Independent Practitioner Today that private consultants and GPs should gear up to promote their services to thousands of ‘the missing’.
Jane Braithwaite, managing director at Designated Medical, said: ‘We know people are not getting the treatment they need or getting diagnosed. There will be patients searching for private doctors to look after them because the NHS is playing catch-up.
‘Independent doctors need to think how they can get the message over of what they can offer to patients. People will be anxious about costs and treatment because they’ve been NHS in the past.
‘Private doctors, clinics and hospitals need to acknowledge the issues, recognise patients may be looking at their websites for the first time and reassure how they will look after these patients.
‘It needs to be about giving the best care and managing the cost of it. A doctor who wants to get the message across needs to say they are aware of the cost fears and, acknowledging this is a concern, demonstrate they will offer a service that makes it a worthwhile investment.’
Of those people who believe they have developed medical conditions during the crisis but have not sought a medical diagnosis for fear of catching Covid-19, 22% say it is linked to their mental health, followed by 13% who say it is a skin condition.
Some 7% fear they have developed a heart condition during the crisis and 1% – nearly 101,000 people – think they may have cancer, says Zegami.
Chief executive Roger Noble said: ‘Our findings are very alarming.’
Zegami commissioned the market research company Consumer Intelligence to survey 1,021 people from across the UK, representing the UK’s demographic profile. Interviews were conducted online between 13 and 16 November 2020.
||Estimated number of adults in the UK who have been diagnosed with this medical condition but have avoided seeing their doctor/going to hospital during the crisis to reduce their chances of catching Covid-19
|Mental health related
|Other/prefer not to say
To deliver a great patient experience, you need to deliver excellence consistently. Every single encounter with your patient makes a difference. To set the scene, I would like to use the words of the great rock musician Bruce Springsteen: ‘Getting an audience is hard. Sustaining an audience is harder. It demands a consistency of thought or purpose and of action over a long period of time.’ This quote obviously relates to producing music and performing, but his emphasis on ‘consistency of thought or purpose and of action over a long period of time’ is equally true for your focus on your patients.
There is plenty of evidence that a long-term sustained focus on any area leads to improvement and that is what you are aiming to achieve in your own practice, clinic or hospital. In your work with patient experience, you started by defining your patient experience strategy, setting out your vision, which forms your guiding map of what you want your practice to be and setting your objectives to achieve in order to have this vision. In last month’s article, we focused on measuring patient experience, discussing the various methods of doing so, including surveys and focus groups, and the importance of capturing and presenting the data in a format that can be easily understood and used.
Identify what patients are telling you.
The next step in the process is to reflect on the findings from the measurement activities to fully understand what your patients are telling you. Identify the highlights and low- lights. You will celebrate the high- lights with your team, as these show the respects in which you are delivering a very positive experience for your patients. The lowlights are where you will need to focus more attention, as these are the identified areas for improvement. Even if all your results are good, I would encourage you to focus on the lowlights. The results may not seem to be disappointing, but there is always room for improvement and focusing on consistent improvement is what you are aiming to achieve. I would suggest choosing three lowlights and create an improvement plan for each of these. The time-scales can vary, but a quarterly plan with monthly review points would allow enough time to deliver and measure improvement, while the monthly reviews will ensure you and your team retain a focus on following up the actions and improving patient experience. The monthly reviews will come around very quickly.
Agree who will take ownership of the improvement plans and who will develop them and manage their progress. I would suggest the overall owner is a senior individual within the team to ensure the right level of focus is given and that actions can be delegated with authority. But you may want to choose a team member to create the actual improvement plans and own the management of the process.
How will your improvement plans be developed?
Every individual who interacts with your patients, from your marketing manager through to the receptionist at the hospital where you operate, is a member of your own patient experience team. But it may not be possible to involve every individual in the development of the improvement plans, although, ideally, you want to involve as many as possible. Involving people at the creation stage is more likely to result in their buy into the process. The best method might be to set up a 30-minute team video call, but, prior to the meeting, circulate the results of your survey, high- light the three lowlights you are going to focus on and ask everyone to come to the meeting prepared to suggest ways to improve. During the meeting, everyone should be encouraged to contribute their thoughts and ideas, and this is more likely to occur in an open culture where individuals know that their input is valued and will be considered seriously. In an open culture, you will receive lots of suggestions and you will need to consolidate on a few actions which you all agree will deliver the best results. For those who are unable to take part in these early discussions, ensure you invest time in communicating your plans with them and giving them the opportunity to contribute. Your improvement plans are basically action plans describing what actions will be taken, by whom and by when. They should be short, very clear and easy to review. Many of you will be familiar with the SMART methodology: Specific, Measurable, Actionable, Realistic, Timescales and this would be a good tool to use. Your success will be measured when you next review your patients using the measurement strategies you implemented previously. If you are running ongoing surveys, you will be able to review the results monthly. If you are running one-off surveys from time to time, your implementation plan should include an action to run a new survey to measure improvement in the key focus areas, ideally quarterly.
Barriers to improvement
There is much research to show that middle managers can be a barrier to the improvement of patient experience, and the reason for this relates to their objectives not being aligned. The leaders and senior members of organisations are committed to improvement and intrinsically believe that it is vital. The front- line staff are engaging with patients every day and they want to deliver the best experience possible. But often middle managers are tasked with making the business more efficient and more profitable and this does not lead to a focus on improving patient experience. To engage middle managers fully, their objectives and key performance indicators need to include goals for improvement in patient experience.
Embedding an improvement culture
If you follow this plan, you will be reviewing the progress of your actions in your improvement plans monthly and measuring for improvement on a regular basis, ideally quarterly. Every three months, you can review your highlights and lowlights and change the focus of the improvement plans, if appropriate. Once each year, you can invest time with your team reviewing your patient experience strategy. Is your vision still relevant? Are your objectives and your measurement criteria still correct or do they need refining?
Patient expectations do evolve over time
The experience of living through 2020 has taught us many things, but one important lesson is that change is inevitable and can be drastic. The growth in telemedicine has been phenomenal and is a good example of how delivery of the patient experience can alter, and very quickly. Not so long ago, our patients would regularly pay their invoices in person by cheque and we would do a weekly bank visit to pay them in, and then BACS transfers became more popular. Nowadays, it is common for patients to receive a text message containing a link to a payment page where they pay by credit card. I believe that online appointment booking will become increasingly popular over coming months and we will make greater use of video in a broader range of applications. While we cannot predict everything that will happen as we adapt to new ways of working, we can ensure we deliver a positive patient experience. This process described here, of continual review, will ensure that the focus on improving patient experience is embedded in your team culture and happy patients will equate to the ongoing success of your practice.
‘You can’t manage what you can’t measure’. This well-known quote by management thinker and ‘the founder of modern management’, Peter Drucker, is a great way to set the scene for this month’s article in our series on patient experience. You cannot know whether you are successful unless success is defined and tracked. To improve patient experience, we need to measure.
What are you measuring? To measure anything requires clear criteria to measure against. Earlier in the series, as part of defining the patient experience strategy, we discussed the importance of setting your vision, which describes what you want your practice/clinic/hospital to be and also your objectives to ensure you achieve this vision.
These will be important, as they will now become the basis for your measurement criteria. As you set out your measurement criteria, it is useful to think ahead about how the findings will be used. It is important to measure the right things that will allow you to track improvements. In the US, there are a set of trademarked surveys called CAHPS surveys, which stands for Consumer Assessment of Healthcare Providers and Systems. These have been created by the US Agency for Healthcare Research and Quality and are designed to report on the aspects of patient experience that are important. They are free to use and may well serve a useful purpose within the UK market too. The measurement criteria you choose will obviously depend on your own vision and objectives, but looking at the questions asked in the CAHPS survey is helpful for inspiration.
As an example, if one of your main objectives is to ensure that patients can book an appointment in a timely manner within your clinic or hospital, you may choose a measure such as the following:
In the last six months, when you needed care right away, how often did you get that care as soon as you needed it?
The patient would be prompted to choose from the following answers:
Another important objective for many healthcare providers is to deliver information in a way that patients can understand and an example measure, seen in the CAHPS survey, might be as follows:
During your recent visit, did your healthcare provider explain things in a way that was easy to understand?
- Yes definitely
- Yes somewhat
This same format of answers applies to other questions asking the patient if the doctor spent enough time with them, listened to them and respected them. While the CAHPS templates will provide you with assistance, it is important that your measurement criteria measure the aspects of your service that are important to you.
How will you capture the information? Having defined your measurement criteria, the next step is to decide how you will survey your patients and capture their responses. You will also need to decide whom you will survey. Will you ask every patient or a subset of your patients?
We all know that responding to surveys can be tedious, so your challenge is to ensure patients are surveyed in a manner that encourages participation. One important factor is to ensure patients are aware why. If they are being asked to take part and how the findings will be used to improve care If they understand the impact their feedback will have, they will be more likely to take part. It is also important to use several different means of engaging with patients, as some ways will appeal to some groups more than others.
Technology solutions: Technology offers us numerous options including email, SMS messages and the use of a computer tablet within the hospital or clinic environment. The beauty of using technology is that it reduces the burden on healthcare staff, but you should not rule out good old-fashioned paper-based surveys, as these may appeal to some patient groups more than technology, but it will, of course, be more time-consuming to collate the responses.
Surveys can be designed to give us data that can be presented in graphs and spreadsheets, which are easy to understand and to monitor trends over time to look for improvement. The most used survey tool in the UK is Survey Monkey, although there are lots of others. Survey Monkey offers a limited free service, but for a reasonable annual subscription, you can access numerous template surveys, some of which are designed for the healthcare sector, including the CAHPS templates described previously. Using technologies such as Survey Monkey to run your surveys also reduces the burden of analysis, as they contain embedded tools to present the data in manageable ways. If you create and run your own survey, you will need to plan for the overhead of collating the data into a useable format. There are also specialist companies focusing on the healthcare industry that provide measurement and analysis of patient experience and cater for all sizes of healthcare businesses, from individual consultants through to large healthcare establishments
Patient interviews: As well as surveys, you could also consider more descriptive patient engagement such as patient interviews and focus groups. The information gained will be harder to present graphically, but will undoubtedly offer some informative knowledge. An interview could even be an informal chat that takes place at the end of a consultation or during a ward round, with each patient being asked a consistent set of three questions and their answers being manually collated. You could also engage your medical PA in the process, asking them to ‘survey’ patients, by phone or email, following their appointment. Like all businesses, healthcare providers receive complaints from patients, and these can provide valuable insights into your patients’ experience and should be included as part of the data collected. At the other end of the spectrum from complaints, I am sure you receive ‘thank you’ letters and compliments from patients regarding the care you have provided. These also provide valuable insights and will highlight the most positive aspects of the patient experience you are delivering.
How will you analyse the data and present it? Once you have run your survey and the data is captured, it needs to be analysed and presented in a meaningful way to ensure it can be used to develop action plans for improvement. You will need to agree who will do the analysis and presentation and continue to do so on a regular basis. If you are using a survey tool, this may not be a significant overhead, but if you plan to run your own survey, the collation of the data will take some time to manage. The output produced should be presented in a manner that is easy to understand by you and the rest of your team. It should be in a format that allows for the measurement of trends over time, so ideally in a spreadsheet or a graph. And the more data that can be collected over time, the more informative the findings will be.
The next stage is to use this valuable information to produce improvement plans enabling you and your team to focus on a small number of areas, usually where you have received lower scores or less positive feedback than you would like to receive. For each of these areas, an action plan should be developed to ensure improvement over time, and this will be the subject of next month’s article. I look forward to answering the following questions next month:
- How will your improvement plans be developed?
- Who will own the improvement plans?
- How will you embed the focus on patient experience in your organisation?
- How to make patient experience a top priority for the long term