Changing Practice Project- Promoting Leadership and Teamwork

Anokha Oomman1, Tracy Sandell1, Susmita Oomman1

1. Hywel Dda Health Board, Haverfordwest, SA61 2PZ

Introduction
Leadership is a requirement for all doctors, as laid out by the General Medical Council (GMC) publication Tomorrows doctors, Good medical practice. Good medical leadership is essential in order to be able to deliver high quality healthcare. Despite this, medical career progression has traditionally seen leadership lack credence in comparison with technical and academic ability1. Medical Leadership Competency Framework (MLCF), jointly developed by The Academy of Medical Royal Colleges and the NHS Institute for Innovation and Improvement states the leadership competencies that all doctors need to develop and which is now being incorporated into undergraduate and postgraduate curricula and assessment processes1,3. The purpose of this is to ensure that medical students and doctors develop a wide range of leadership knowledge, skills and behaviours during their training5

Leadership and Doctors

Leadership is a key part of doctors professional work. It is a requirement of all doctors as laid out in the General Medical Councils (GMC) publications Good Medical Practice, Tomorrows Doctors and also Management for Doctors. Doctors have a legal duty broader than any other health professional and therefore have an intrinsic leadership role within healthcare services. They have a responsibility to contribute to the effective running of the organisation in which they work and to its future direction.

Changing Practice project

The changing practice project was introduced in 2013 by Cardiff University to address the changes suggested by the MCLF framework. This project was designed for final year medical students. The project gave the students a chance to identify an aspect of care for improvement and work in groups to measure performance against a gold standard as a prelude to changing practice4. On completion of the Project, the students were expected to be able to: Understand the principles for the Model for Improvement Recognise the need for integration and teamwork rather than individualism for best practice in healthcare Understand how to make small healthcare improvements by using plan, do, study and act. Describe the role of measurement in service improvement Communicate effectively in various roles for example as patient advocate, teacher, manager or improvement leader Understand how to use audit to improve practice Educate and inspire others by presenting your project at the Changing Practice Showcase during the Practise to Practice block.

Student feedback
The feedback we received from the students involved in this project at Withybush General Hospital has been positive. They have enjoyed working together as a team and developing a set of skills and behaviour, which will enable them to engage and lead in highly complex, rapidly changing environments in the future. The students felt like they made a difference in the delivery of patient care. Some felt that the project helped them understand what an audit was and took away the fear associated with it. They were particularly pleased that their work was appreciated by the senior doctors.

Aim
Use the changing practice project to give students the opportunity to think critically about healthcare delivery in Wales; and through leadership and team-work transform and improve local healthcare

Did they make a difference?

The completed audit was presented at the whole hospital audit meeting in November 2013 where it was received well. Following the presentation, funding has been allocated from the League of friends of Withybush General Hospital to pay for clocks and calenders with writing boards for every ward at WGH as recommended by the students.

The project
The final year medical students doing their placement in Withybush General Hospital (WGH) chose to audit the environmental factors affecting patients at risk of Delirium. They identified that the wards were not adequately equipped with the environmental stimulus recommended by NICE guidelines. The project allowed the students to build evidenced-based methods and data assessment skills. The recommendations of their project (e.g: clocks and calenders attached to writing boards) has resulted in providing a better service and resulted in quality improvement in service delivery and patient experience

REFERENCES
1. The Medical Leadership Competency Framework, The National Institute for Innovation and Improvement http://www.institute.nhs.uk/assessment_tool/general/medical_leadership_competen framework_homepage.html (accessed 30th January) 2. Oliver J Warren, Ruth Carnall; Medical leadership: why it's important, what is required, and how we develop it. Postgraduate Medical Journal 2011;87:27-32 3. Clark J, Enhancing medical engagement in leadership. In View 2006;10:1415.

My Role
My role was that of a facilitator. I helped guide and support the students through the various stages of the audit project. I also ensured that the students worked together as a team to conduct the project. My overall purpose was to ensure that the aims of the Changing Practice module were met.

4. Cardiff University. Changing Practice Handbook. Cardiff: Cardiff Univeristy, 2010 5. Academy of Medical Royal Colleges. Guidance for Undergraduate Medical Education: Integrating the Medical Leadership Competency Framework. http://www.aomrc.org.uk/component/docman/docview/227 undergraduate-guidance-for-medical-education (accessed 30th January 2014).