‘Doctors & Managers. We’re on the Same Side. Right?’

You forgot we’re a Team.

So recently I was part of a NHS Change Model Twitter Discussion between managers, consultants, some doctors and some patient group representatives. About a third of the way through a patient group representative made a statement along the lines of, “Aren’t we all on the same side?”.

It got me thinking.

Are we really?

I mean in a perfect world we’re all their to treat the sick and to relieve the pain of those who sadly can’t be treated anymore. Everything from budgets, to equipment procurement, leadership and clinical practice is supposedly there to treat patients and improve peoples’ health.

But is that how we really think about things? Let’s take a closer look.

‘I want to be a Doctor so I can help People!’

Oh really? Did you consider social work or charity work in that case?

I kid, I kid! A little…

You see doctors and nurses treat people on a daily basis so it becomes second nature and because we’re just humans other factors start to take precedent. Whether it’s overly complex and bureaucratic training systems, the hunt for jobs or the never-ending chain of exams and assessments somewhere along the line everyone gets a little jaded.

With the weight of the world they’re carrying on their shoulders from house officer to consultant it can become and endless struggle even for the most optimistic. It’s there and politics doesn’t make it any easier because we all have mortgages and bills to think about.

BUT. Above all, we all care about our patients and many doctors know what will make a difference but suggestions from the frontline often fall upon deaf ears so much so that they succumb to the world of procrastination because…

‘We’ve got to balance the books!’

‘Money, money, money. That’s right, I’m a manager and I need to balance the budget. I need to generate income and cut costs any way I can.’

I exaggerate. Slightly.

Doctors often complain that’s all managers care about and nothing else. Here’s the thing guys we can’t have hospitals without money.

That’s the world we live in and somehow we need to get around often enormous costs to even get by on a daily basis let alone forecast the future. We’re happy to give managers that burden and expect them, often with no experience of healthcare, to be able to balance the books whilst thinking directly about life on the frontline.

Even patient care has become a set of statistics and numbers because of never ending government targets. Not meeting targets? Get fined! More numbers! No wonder none of them have any time to even consider taking the time to learn about the stresses and strains frontline healthcare staff go through on a regular basis.

And where do all these good natured targets come from?

‘Vote for Us and We’ll put the NHS first!’

Promises. Party politics. Oh they’d promise us the world to get into Westminster, the White House or wherever else.

It’s an unenviable task to balance the ultimate national budget and often the decisions come from people who have never spent a day in hospital beyond the occasional visit to declare a new facility open. Even if you spend days shadowing doctors unless you do the night shifts and  the on-calls with dwindling resources or staff then you don’t really get a flavour of the harsh realities of healthcare.

If you haven’t been at least a manager in a hospital and tried to negotiate and compromise with doctors and nurses then you’ll never understand the dynamics at play.

But you’re calling the shots. You can invest in think-tanks and what not but unless they’re engaging immensely closely with doctors, nurses and managers and listening to patients then it all won’t mean anything.

The biggest problem is that whenever anyone tries anything meaningful by the time they get anything from paper to reality they’re out of power and everything gets repealed by the new government or administration and we’re back to the drawing board.

So What do we Do?

Sure, we have to talk. We have to listen.

It’s not enough. We have to experience. We have to develop insight.

Doctors need to spend time observing what managers do and we need to develop a training program for junior doctors with an active interest in management.

Managers need to experience what it’s like to be working as a doctor or nurse in the middle of the night or on call. The trials and tribulations of accessing patient records, getting equipment and handling emergencies and failing computer systems.

Just a little insight could take us all a step forward. On the same side. Caring for our patients the best way we each know how.

SHARE, FORWARD AND RETWEET!

Dr Saif Abed
Founding Partner
AbedGraham Healthcare Strategies Ltd
www.abedgraham.com

 

20 THINGS DOCTORS WISH WOULD HAPPEN

1. Printers working.

2. Computers working.

3. Fully stocked equipment storerooms.

4. Logically laid out equipment storerooms!

5. Rotas with an appropriate number of staff.

6. Locum staff who understand the word ‘responsibility’.

7. Not being bleeped 4 times within two minutes by the same person.

8. Understanding that you can’t be in more than one place at the same.

9. Other specialties understanding that when you’re calling them it’s not to ruin their lives but because you’re asking for their help.

10. Councils realising that doing an audit because it’s compulsory doesn’t improve clinical practice.

11. Managers realising that statistics can’t replace frontline experience.

12. A ‘Thank You’ from anyone goes a long way.

13. ‘I’m sorry’ works both ways and also goes a long way.

14. When you call me make sure you’ve you’ve got your facts straight.

15. If its 1430 and I’m free give me work to do NOT when it’s 1755.

16. Porters arriving on time.

17. iPads. We need more of them.

18. Doctor’s rooms that are stocked and have no rats.

19. We’re not rich. Courses & exams don’t have to cost so much.

20. We’re human.

SHARE, FORWARD AND RETWEET!

Dr Saif Abed
Founding Partner
AbedGraham Healthcare Strategies Ltd
www.abedgraham.com

“How Hospitals Waste My Time…”

It’s 3am and You’re the only Doctor On Call…

You’ve got a sick patient who you’ve been called to see on a ward you never knew existed, you can’t find the nurse who called you, you can’t find a blood test bottle, you can’t find the right investigation request form and the operator seems to be on strike. Whether you’re a doctor, nurse, manager or hospital executive you’ll have encountered someone who’s been through one of those nights.

So it got me thinking. I spoke to a few people. Doctors, nurses and managers.

We got chatting about what really annoyed us about the wards, clinics and hospitals we worked at. What would we change?

If I had a penny for every gripe we came up with then I would cash those gripes in at the bank right now and officially retire. Alas, instead I am blogging about the aforementioned, yet cathartic process we went through. So let’s look at some of the organisational issues facing your average hospital.

1. Equipment

My goodness the total amount of time I have wasted on a solitary night on-call trying to find a needle, syringe or blood bottle, nothing really important obviously, verges on hours. It’s not like I had an ill patient to look after or anything. Some rather clever designer clearly felt that every ward should have its storeroom cupboards arranged differently and subsequent managers felt it was best to layout all the LIFE PRESERVING  equipment in completely obscure places. I haven’t even got to the evening I spent an hour searching for a mythical endoscope…

2. Portering

Patients with chest problems quite often need chest x-rays. When patients have advanced chest conditions they require chest CT scans. When patients have abdominal pain they quite often need abdominal CT scans.

So. The genius who thought the CT scanner should be located on the equal and opposite end of the hospital must be a real sadist…

But we have porters I hear you cry! Alas, it often seems to be a portering system supplemented by untrained junior doctors and nurses. No matter, it’s not like the patients’ care is being delayed in any way shape or form. Its not that the patient needs to be transferred to Intensive Care or really needs to be taken for dialysis (located somewhere in Narnia).

3. Operator

“Microbiology.”

“You are being put through to Mr James Holliday.”

“No, Micro…”

“Sorry I did not catch that, please repeat your request.”

“Microbiology.”

“You are being put through to Neuroradiology.”

And that’s a human operator…

4. Paperwork

Whether its’ filling in or finding paperwork it’s all infuriating. From the patients’ folders that seem to have an uncanny ability to spill their contents everywhere or their ability to lose the all important test results or the request forms that always seem to be elusive at the best of times.

Paperwork. Man’s worst enemy since AD 105.

The Solution?

Now that list was by no means exhaustive but it gives you a flavour of the types of issues that really aggravate healthcare professionals on the front line. I haven’t even got to the patient referral systems but I digress. What’s the answer?

Well, the good news? It’s all a matter of thoughtful re-organisation. A collective feng shui.

The bad news? It’s going to require some cash money.

The reason I transitioned from practicing physician to healthcare consultant was because many of the problems facing healthcare can’t be summarised on a spreadsheet or in a pie chart. They are experiential, frontline experiences. They can be fixed but it requires a collaborative  effort on all sides to sit together and brainstorm the solutions (some prefer painstorming).

Since we can’t go around tearing down hospitals and rebuilding them there are limitations on what we can do but we can still make marked improvements. What’s exciting though is that there is significant global investment occurring in healthcare especially in the Middle East, Asia and Latin America and it’s in those locations where we can cultivate effective healthcare systems from the get go.

A little bit of talk might save us all a lot of time.

Agree/Disagree? Have Your Say, Tweet Me @Saif_Abed & if you enjoyed my blog please ReTweet, share and forward it on!

Dr Saif F Abed

Founding Partner

AbedGraham Healthcare Strategies Ltd

http://www.abedgraham.com

“This is how I would sell the NHS Brand.”

In my last blog post I put forward my applause and support for the governments’ plans to encourage NHS trusts to sell and develop their brands abroad such as Great Ormond Street Hospital. Today I want to explain how I would go about taking the NHS brand to the global market. 

It’s going to involve some harsh truths.

First thing’s first. The NHS and the way it’s run here at home, in Britain cannot work abroad. The system is bureaucratic, lackadaisical, financially unsound and unsustainable. Well meaning chief executives are constrained by government targets and middle management lack the necessary skills to manage single units let alone hospitals and trusts. The system is only getting by because of a combination of continued (though eventually dwindling) funding and the vocational efforts of healthcare staff ( though increasingly demoralised).

No-one wants to buy that. And that’s not what we’re selling.

We have to shift away from the mentality of the suffering NHS to that of the awe inspiring British healthcare system. We have to start thinking like a corporation because we will now be in competition with a range of international healthcare institutions.

We have to start thinking like a multi-national.

So how do we do it? What is there to sell? Quite a lot actually but of all there is one key factor.

Reputation

Let’s be under no illusions here. Britain has been one of the pioneers in healthcare research and application for decades if not the majority of the history of modern medicine. From Gray’s anatomy (the book!), Jenner’s smallpox vaccine to the invention of the CT scanner we’ve always been on the cutting edge. That’s recognised with hundreds of foreign students coming to train here and even more coming as medical tourists.

No matter what your impression is of our hospital wards or your local GP they are not synonymous with the views of the global markets we will target. The British education system attracts foreign students aplenty and that’s because the country is seen as having great minds and systems to impart knowledge and skill. It is those very assumptions, based on fact, which will enable us to take our services abroad.

So where do we go? We needs markets with money, an appetite for investment and preferably those who already have ties with Britain.

Location, Location, Location!

The money’s in the middle east. Specifically, it’s in the gulf region. Especially, the UAE, Saudi Arabia, Kuwait and Qatar.

The governments are pro-active in their involvement with foreign investors especially if it leads to the increasing development of profitability of their nations. Particularly, nations like the UAE, Kuwait and Qatar value the role of infrastructure development and knowledge services. In time so will previously war torn nations such as Iraq.

Healthcare fulfils both these needs. We’re not limited to medical care either, we have world renowned medical training facilities which we can expand abroad too. Harvard Medical School signed a contract to develop an equivalent satellite facility in Dubai in 2009. I can foresee this can be tied into the funding for our homegrown doctors and nurses but I digress.

So How do we Do it?

We have to treat healthcare as an industry and we need to treat the global NHS brand as a profit making exercise. We have to plan the process as a means to get as much money back to Britain to fund our own services.

The bottom line is profit.

We need to extract dedicated individuals from the NHS Confederation, UK Trade and Investment, Foreign Office and the appropriate Royal Colleges of Medicine and Nursing to form a union of experts to analyse the most profitable trust brands, the market, repackage the product and aggressively seeks global partnerships and contracts.

To allow each NHS trust, with some (yet, unspecified) assistance to go about this mammoth task itself is absurd.

Business 101

These are the questions that needs to be answered by the task force I suggest needs to be formed:

1. Which services do medical tourists demand when they come to the United Kingdom?
2. Which private hospitals do they use in the United Kingdom?
3. In which NHS trusts are high demand private practice doctors based?
4. Which NHS trusts have the highest percentage of private practice as a part of their balance sheets?
5. How do their financial books look?
5. Which nations do we have already active, high-yield investments with especially in knowledge based services?
6. Can they provide the necessary infrastructure for us to use or must we provide it ourselves or is their a relevant home firm we can partner with?
*7. What role can private British healthcare firms (providers/insurers) play?*

*(I have put point 7 between asterisks simply because it’s a factor that has not been considered or spoken of yet. I am an ardent advocate of public-private sector collaboration and I believe profit creates an incentive for innovation and initiative but I will reserve discussing point 7 for a future blog.)

There are still many unanswered questions but we need to accept why this initiative has been proposed. It’s to make money so that we can fund healthcare at home. It can be done as long as we start thinking and behaving like we are a private sector institution but it has to be a facilitated, regulated and closely monitored.

Providing excellent clinical care abroad could be the reason we can keep providing it at home.

So that’s my view! Tomorrow I will discuss how we have to regulate this process so that patients at home reap the dividends.

Agree/Disagree? Have Your Say, Tweet Me @Saif_Abed & if you enjoyed my blog please ReTweet, share and forward it on!

Dr Saif F Abed
Founding Partner
AbedGraham Healthcare Strategies Ltd
www.abedgraham.com

 

The NHS Brand: Let’s Get our Money’s Worth

It’s time we got our money’s worth. Despite my scepticism of the image portrayed by Danny Boyle of the NHS it’s clear that British healthcare is admired globally and rightfully so. It make’s me proud as a British trained doctor and as a citizen.

But I’m a strategist. I see an opportunity. We have to make the most of it.

Today came the announcement that British hospitals will be advised to leverage their brands abroad for private practice and investment. The plan being that we can use this money to invest in the care of patients in the NHS without spending any taxpayer money since these foreign practices will be funded through the private practices of NHS institutions.

I applaud this move. I have constantly remarked that innovation will allow the private sector to work seamlessly with the public sector and this is just one example.

The NHS is running out of options when it comes to funding and care quality. It’s sucking money from our budget like a black hole and its unsustainable. NHS institutions are increasingly in the red and whatever you may think, less money= poor care and no money = no care. We need a solution and I’ve advocated the role of a moderated private sector as a winner. The role of Circle at Hinchingbrooke NHS trust is one.

US and European hospital groups have for a while been exploiting their brands in the form of medical tourism and only recently has Moorfields Eye Hospital, an institution I’ve had the good fortune of working with. Moorfields Dubai has been profitable for the last three years and the money is used to fund the care of their NHS patients in the UK.

I can guarantee that there is demand for British born services particularly in the gulf region and from many parts of the Far East. These will be patients who will happily pay a premium for our services which are world class.

We’re sitting on a gold mine!

I can already hear some groups calling for the cliched fear of profits over patients care. Utter rubbish in my humble opinion. The sole reason private providers can be competitive is because they provide excellent care. Those who can’t, don’t. To allay any further fears the government must take a pro-active role in the regulation and overseeing of private firms but it is because they have a profit incentive that they can be innovative.

We must encourage collaboration between the private and the public sector and if it’s NHS trusts that can diversify across both then we will start a process that will sustain our NHS for many years to come.

We’ve built a brand. We’re proud of it. Let’s use it and look after ourselves for a change.

Have Your Say, Tweet me @Saif_Abed and if you enjoyed it then ReTweet and Forward my blog!

Dr Saif F Abed
Founding Partner
AbedGraham Healthcare Strategies Ltd
http://www.abedgraham.com

The Social Networks Driving Healthcare Forward

Social media is everywhere. It’s an intrinsic part of your life whether you’re really aware of it or not.

If you’re reading this then you’ve engaged in social networking. We’ve connected whether it’s through LinkedIn, Facebook, Twitter, WordPress or whatever else. However, and as I’ve mentioned before, healthcare lags behind most industries in its uptake of management solutions and innovation.

In my last blog I discussed a surge in the use of iPads in hospitals and it therefore only makes sense to look at the social networks and apps that propel smartphones and the like. Since the primary premise of a social network is to connect and formulate a community then it can have a perfect role in healthcare connecting patients, relatives, carers and physicians. So let’s look at some examples:

1. Curetogether.com

An open-source, crowd-sourcing type of website where patients with conditions in common can come together to share qualitative and quantitative information regarding their conditions and treatments. The purpose of this is to provide accurate information for patients but chiefly to spur the development of ideas and research in their respective fields.

2. PatientsLikeMe.com

A for profit company that allows patients to share quantitative and qualitative information providing a database of information for people to browse and learn from about conditions, treatments and interventions. Information is then shared with private healthcare firms and is another way of driving research or feedback in the private sector.

3. MedHelp.org

Another community website to share information but uniquely it has a range of monitoring tools that can be used for self-monitoring and reporting. A great way of getting patients to become more pro-active in managing their health which can be shared with their doctors to allow them to be more acutely involved in the management of their patients.

Since, information is a powerful currency by itself, both the pharmaceutical industry and the medical community has taken an interest in social media. Almost every major pharmaceutical company and large hospital trust or body has a social media presence in the form of Twitter, Facebook, LinkedIn or even a blog.

Pharmaceutical companies are beginning to study consumer trends and perceptions so that they can develop, improve and target their products more effectively. Hospitals are using social networks to gather and respond to patient feedback and experiences. The Mayo Clinic is a case point with a fantastic social networking web presence through their Mayo Clinic Center for Social Media.

As patients become more web savvy there is a range of social networks offering direct, online consultations but these traverse a grey area in terms of the extent of care that can be provided reasonably and ethically over the internet. But one great perk is the role of the social network to connect physicians to one another to confidentially and anonymously discuss patient cases either within their own hospital or through a wider network. An example of such a website is iRounds.net which allows physicians in a hospital to share data, communicate and even manage their schedules.

Most of these websites are ridiculously difficult to find unless you know where you’re going and what you’re looking forward. The research into the efficacy of these services is minimal at best but a trend is clearly developing and it’s unlikely to slow down any time soon.

As a tech savvy doctor (if I do say so myself!) I think this technology is great because it would improve my ability to look after my patients and do my job. As a management consultant I think it can only improve productivity, reactivity and even profitability. Here’s the thing though if we’re going to do it then we need a concentrated effort with investment and education by both private and public services.

It’s not like money is growing on trees but this may be one investment that will reap dividends for many years to come.

Have any more examples? Have your say, Tweet me @Saif_Abed & if you enjoyed today’s blog please ReTweet and share it!

Dr Saif F Abed
Founding Partner
AbedGraham Healthcare Strategies Ltd
http://www.abedgraham.com

Spotlight on Tech: The iPad in Healthcare

Apple changed the game. I have to admit that before the iPad was launched I was sceptical, I mean I’ve got a laptop and it does everything. This’s just going to be a tech fad.

I was wrong. The day I lay my hands on one I knew I had to have one.

Shortly, after that I began reading stories about iPads popping up in hospitals and clinics around the world. Even in the cash strapped NHS there are iPad initiatives! Since, I started making the transition from doctor to consultant I’ve become a strong advocate for the role of consumer technology on the wards and in the clinic. Today, I’ll present some of the potential roles of the iPad in healthcare that could make a difference.

1. In Multi-disciplinary Meetings

During my time in intensive care we would have daily meetings to discuss all our patients involving a whole host of different specialists. The microbiologists always needed access to their own private network and so with the help of IT they funded a departmental iPad that patched into the Windows based Microbiology network. This allowed them to access all our patients’ test results, specimens and even adjust the tests that had been ordered. What’s more they could do this all at the bedside too when we moved to our walking rounds.

 

2. On the Ward Round

Ward rounds are the most tiresome of experiences for junior doctors as you walk around a ward seeing patients and collating a list of jobs for each patient from ‘the boss’. Those with initiative figure out ways of doing jobs as they go along, whether its carrying stack of investigation forms, preparing results in advance or even wheeling around a desktop computer (a COW, Computer on Wheels). However, some have been known to bring their own personal iPads, get them patched in and so be able to access, view and order tests as they go around. Then there are all the apps and calculators you can get…

Marvellous.

But it goes further than that as some NHS trusts are using iPads at the ends of beds for patients to record their service feedback and experience as a part of a trust wide improvement exercise.

Patient feedback at Ipswich Hospital

3. Radiology & Surgery

Access to patient imaging is absolutely crucial for surgery, whether its for pre-operative planning or whether its for orientation intra-operatively the two fields are inextricably linked. The facts that a sterile, cassette cover still seems to allow the screen to work even whilst wearing gloves really could be a game changer. Accessing, adjusting and editing images in front of you as an operation goes could make life easier for the surgeon but may be an exemplary intra-operative teaching tool for junior surgeons.

3D Virtual Reality algorithms are already being used by surgeons to allow them to see exactly where they are by holding their iPads over a patient in theatre to see where they are in relation to the organs or pathological tissue they are operating on.

4. In the Community

Most healthcare is undertaken in the community through family practitioners. They treat the coughs, the colds, the diabetics and the recovering. Most of their work involves monitoring and health checks through both home visits and practice appointments. A lot of their work is done through nurses in the community. iPads could be used to remotely access the GP surgery whilst out on a visit, it can be used by extension to share data quickly between the remote and base site.

The multitude of apps available on for all Apple devices mean that patients can also share data with their doctors. They can keep a track of their sugar readings, blood pressure, diet and a whole host of other measures via their smart phones which can then be accessed by their doctor on their own device or even from home via their iPad.

I mean doctors are already getting on the bandwagon creating apps to even monitor pacemakers and defibrillators remotely! Institutions in the states are using software which will notify a doctor via mobile if a patient has an ‘alert event’ which more often than not involves a smartphone and in all likelihood an Apple device.

The iPad is just another piece of technology but it’s so flexible that it’s only limited in its use by our capacity to innovate .

Has the iPad made a difference to you? Are you in healthcare? Have Your Say, [RE]Tweet me @Saif_Abed

Dr Saif F Abed
Founding Partner
AbedGraham Healthcare Strategies Ltd
http://www.abedgraham.com