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Finding the right balance in Clinical Leadership training

Author: Dr Jennifer Palfrey
23 October 2017

Dr Jennifer Palfrey is doing a Darzi Fellowship, a Clinical Leadership programme. Here she tells us about taking on tasks she’s never performed before compared to the comfort zone of her previous clinical work, and how she plans to research remote consulting services for hospices.

Six months into my Darzi Fellowship and more than ever I am seeing the importance of developing leadership and management skills during specialty registrar training. Medical school, Foundation Years, Core Medical Training and Specialty Training can never fully prepare you for becoming a leader and manager in the NHS or third healthcare sector.

Being a relatively small specialty, Palliative Medicine Consultants frequently take on more management roles earlier in their career. The training programme includes curriculum items dedicated to gaining experience in management, and many trainees complete courses to gain an insight into some of the skills, but it appears that inevitably clinical knowledge takes centre stage with the feeling that management skills can be picked up along the way. It is therefore not a surprise that many feel underprepared when starting consultant jobs and no amount of theory or “dipping in and out” can prepare you for the reality of the challenge.

Through my Fellowship I have had the opportunity to not only learn about the theory but have had the time and head space to experience, practice and more importantly reflect on styles and processes of leadership and management. Medical Director Craig and Chief Executive Nicki, have acted as sounding boards and mentors as I muse over the challenges of change management, celebrate my small wins and voice my frustrations with the system.

The things I am learning are not ground breaking but they cannot be learnt in a book, they need to be lived experiences. I feel as though I am on an accelerated pathway and the highs and lows are therefore accentuated. The Fellowship taught me to embrace this, knowing that often there is no right answer, rather than feeling overwhelmed by the system and then giving up.

I have no clinical obligations and have control of my diary which in itself was quite daunting to start with. Clinical work felt like my comfort zone, I knew generally what my day would hold: ward round, lunchtime teaching and home visits, even if the specifics of this were hugely variable. Now I have few set commitments, I have to structure and allocate time to jobs that I have little knowledge of - how long does it take to write a Gantt chart or to negotiate diaries and room bookings? Some I have massively underestimated whereas others I have completed in half the time I was expecting.

I have the opportunity to work from home, a completely new experience for me. It has its benefits in that I can crack on with work with no distractions and I do not have to battle the traffic in the morning but I also miss the contact with my colleagues and the ability to bounce ideas around. Bumping into people in the corridors are where some of my most helpful connections have been made!

I suppose all of this can be summed up in a few short words: “finding the right balance” and trying to establish that balance is all part of the learning.

I am currently in the project proposal, stakeholder meeting, senior management team approval and project planning stage. Gantt charts, Communication Plans, Lean thinking and Design Sprints were all new to me but having embraced a business mindset I have enjoyed each process and see the potential for using the learning in other areas of my project.

After much scoping I have decided that my focus in Princess Alice Hospice will be on determining the role, benefits and barriers to remote consulting in the hospice setting. There are many perceptions that End of Life Care is too sensitive a subject for consultations over video link and that it is not appropriate for a more frail and likely older population. However, studies have shown that some of these perceptions are not the case; projects in Airedale and Wales have shown that patients usually get to grips with the technology easily and find it acceptable.

There are a number of advantages to remote consulting; less travel for patients and professionals, more efficient use of time, and the ability for other professionals, carers and family members to join consultations when they are juggling other responsibilities. Distance in terms of mileage is not such a problem in our Surrey patch but traffic certainly is. I hope that a co-production approach, engaging with the community team, local GPs, district nurses, patients and carers will highlight the areas of potential for developing a remote consulting service – it will not be for everyone and is by no means a one size fits all, but I believe it has a role that has yet to be explored fully.

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