I was introduced to HSJ editor Alastair Mclellan on day 2, who promptly briefed me on the interview I was to carry out with an executive at $50 billion turnover health care provider Kaiser Permanente.
Day 3 began with a news team meeting in which members, myself included, were expected to bring ideas for publication to the table.
Despite the steep learning curve, I was immediately made to feel part of the news team, and was encouraged to participate in discussion on the publication’s focal areas of health care management and policy.
I was also encouraged to ask around for projects. My eventual niche involved researching the reconfiguration of health services in Greater London, particularly the impact of urgent care centres (UCCs): which A&Es they were attached to – or, in the case of North West London, which A&Es they were slated to replace - and their effect on demand.
Another benefit from being amongst the award-winning news team was hearing expert analysis as stories broke or were being developed, before it became news in the conventional sense. In addition to UCC, I also had the pleasure of deciphering an almighty list of acronyms (DH, CQC, CCG, NaPC, QIPP, NPfIT…) that are clearly never-ending.
Amongst myriad transferable skills, I also learned the thrills and pitfalls of investigative journalism: contacting press offices, for example, and how to successfully conduct interviews via email and telephone as well as face to face. Meanwhile, 3 essay-barren years of medical school had clearly ravaged my writing skills from their GCSE English peak, and they required an overhaul: how to go about writing an article in the first instance, and then how to tailor content to the target audience of a for-profit publication. Suffice it to say that seeing 2 articles published later in the year was worth it.
Another highlight was attending the Darzi's Fellows clinical leadership conference at The King's Fund, where Alastair chaired a fiery debate on the NHS and privatisation, which involved Ali Parsa, chief executive of Circle.
In the short-term, the insights gained from my time at HSJ have provided a boost whilst studying the intercalated Management BSc at Imperial. I imagine completing the internship after the BSc would provide added (though not necessarily better) perspective.
In the long-term, they may yet steer me towards a career in health management or policy, in tandem with the clinical medicine that I enjoy. Regardless, I think all medical students could benefit from more lateral exploration of NHS issues, which (at the time of writing) medical school curricula do not cater for.
The internship required initiative - lots of looking for things to do, as opposed to being told what to do - and as such is probably not for everyone. Disclaimer aside, I sincerely thank Alastair and the HSJ team, and Harpreet Sood and the Diagnosis team for the privilege, and can only recommend applying.
Friday, November 23, 2012
Friday, November 16, 2012
Internship at Bupa – Summer 2012 by Daniel Ketley, 5th Year Medical Student, University College London Medical School.
I began my placement at Bupa with a mixed sense of excitement and trepidation. Having entered medicine straight from school I had no experience of the corporate environment, and had no idea what to expect, or what I would be doing.
I was based at Willow House in Staines, where the people I worked alongside were incredibly friendly and accommodating. Within a few hours I felt part of the team and had been given my first task.
My first project was with the healthcare commissioning team. I was given a project brief and had to develop my approach to the task and plan my work accordingly. The task seemed daunting at first, however I realised that my training at medical school had equipped me with the skills I needed; I just needed to apply them in a slightly different context to what I was used to.
The project was immensely rewarding as I took the task from a project brief through to a completed document which was very satisfying. As a medical student I often offer opinions on what I would do if I were the doctor in a particular clinical case; in this instance I not only had to evaluate the options and offer an opinion, I had to take the process one step further and reach a decision for the report which was something I had not done before.
My second project was working alongside the policy development unit. In contrast to the first project where I worked independently, in this case I was part of an established team which brought its own challenges. I was able to learn an awful lot from the more experienced members of the team, whilst at the same time build and develop my own thinking and skill set.
My time at Bupa taught me a great deal about how healthcare in the UK is organised in both the private and public spheres, as well as the challenges facing healthcare commissioners in the future. I no longer see my time at Bupa as an internship, I think of it as an essential part of my medical degree. The skills and exposure it gave me I have taken back into the clinical environment and will use as a doctor later in my career.
I was based at Willow House in Staines, where the people I worked alongside were incredibly friendly and accommodating. Within a few hours I felt part of the team and had been given my first task.
My first project was with the healthcare commissioning team. I was given a project brief and had to develop my approach to the task and plan my work accordingly. The task seemed daunting at first, however I realised that my training at medical school had equipped me with the skills I needed; I just needed to apply them in a slightly different context to what I was used to.
The project was immensely rewarding as I took the task from a project brief through to a completed document which was very satisfying. As a medical student I often offer opinions on what I would do if I were the doctor in a particular clinical case; in this instance I not only had to evaluate the options and offer an opinion, I had to take the process one step further and reach a decision for the report which was something I had not done before.
My second project was working alongside the policy development unit. In contrast to the first project where I worked independently, in this case I was part of an established team which brought its own challenges. I was able to learn an awful lot from the more experienced members of the team, whilst at the same time build and develop my own thinking and skill set.
My time at Bupa taught me a great deal about how healthcare in the UK is organised in both the private and public spheres, as well as the challenges facing healthcare commissioners in the future. I no longer see my time at Bupa as an internship, I think of it as an essential part of my medical degree. The skills and exposure it gave me I have taken back into the clinical environment and will use as a doctor later in my career.
Thursday, November 8, 2012
Internship at Patients Know Best, July 2012 by Tobi Isaac Obisanya, 4th Year Intercalating Medical Student at Imperial College London
During my 4 week internship at Patients Know Best, I learnt about and got involved in the raw process of starting and establishing a business; to summarize it quickly. But this was not just any business, this was one that was changing paradigms in the way patient care is done.
Working with Dr Al Ubaydli & the PKB team was inspiring, and I would say that I learnt three things from this placement.
One, you need to be passionate about what you do. Dr Al Ubaydli's passion for his work is his best asset because it is only through a true conviction in what you are doing that you will ever be able to get people to one invest in it and two for it to grow and become a sustainable organic organisation.
Two, it takes a good understanding and research of the market/environment in which you want to function to have an impact and carve out a legacy in it.
Three, it takes time to establish anything; a business, a well functional system or idea. Patience & continued belief in yourself & your idea is vital.
It is fair to say that aside from it being all about business, there were also important life lessons taken. I also assisted the companies CFO to create a tangible visual depiction of the companies vision & business plan using IT which was exciting and allowed me to add value to their efforts to raise capital. I completed the internship before beginning my intercalated year in Business and Healthcare Management at the Imperial Business School which I would highly recommend to all medical students.
My time at PKB has been invaluable and given me an edge even in the first 2 weeks of the course, as there were many aspects of business & healthcare I explored during my internship. Although interning at a still growing company can be a bit hectic and your role can be uncertain/undefined at times - it has been an invaluable experience to be a part of and to understanding how this pioneering company is doing the great work it is currently doing and building a bright future for patient care in the ever-changing NHS landscape.
Link to Patients Know Best website
Working with Dr Al Ubaydli & the PKB team was inspiring, and I would say that I learnt three things from this placement.
One, you need to be passionate about what you do. Dr Al Ubaydli's passion for his work is his best asset because it is only through a true conviction in what you are doing that you will ever be able to get people to one invest in it and two for it to grow and become a sustainable organic organisation.
Two, it takes a good understanding and research of the market/environment in which you want to function to have an impact and carve out a legacy in it.
Three, it takes time to establish anything; a business, a well functional system or idea. Patience & continued belief in yourself & your idea is vital.
It is fair to say that aside from it being all about business, there were also important life lessons taken. I also assisted the companies CFO to create a tangible visual depiction of the companies vision & business plan using IT which was exciting and allowed me to add value to their efforts to raise capital. I completed the internship before beginning my intercalated year in Business and Healthcare Management at the Imperial Business School which I would highly recommend to all medical students.
My time at PKB has been invaluable and given me an edge even in the first 2 weeks of the course, as there were many aspects of business & healthcare I explored during my internship. Although interning at a still growing company can be a bit hectic and your role can be uncertain/undefined at times - it has been an invaluable experience to be a part of and to understanding how this pioneering company is doing the great work it is currently doing and building a bright future for patient care in the ever-changing NHS landscape.
Link to Patients Know Best website
Tuesday, October 16, 2012
Problem solving at its best: What it’s like being a doctor in Sierra Leone. By Dr Elizabeth Tuckey, Junior Doctor, A & E West Hertfordshire Hospital NHS Trust & Mr Vernon Sivarajah
The premise of the NHS ‘equal access for equal medical need’ is a distant reality in developing countries. The World Health Organisation estimates that 70% of people in developing countries don’t have access to basic health services.
Like many doctors I have always wanted to work for an Non-Governmental Organisation (NGO) and help to provide medical care to people who need it most. Those of us who have looked into it have found that larger organisations like Medicines Sans Frontier require a minimum six-month commitment which can never normally fit in with our training or annual leave. Thus, many doctors never get a chance to scratch that itch.
But there is another way. I have just returned from a ten day visit to Sierra Leone. A small charity called the Better Lives Foundation runs three medical camps a year, in a small purpose built hospital 88 miles from Freetown in Yonibana.
Sierra Leone is one of the poorest African countries in terms of infrastructure; devastated by a ten year civil war that finished in 2002, there is virtually no clean water and electricity is scarce. The life expectancy is shockingly short at just 42 years and over 80% of medical care is provided by outside agencies.
I was going to take part in the Hernia camp and the goal was to perform thirty hernia operations in ten days with a team of doctors and nurses whom I met at Heathrow airport. None of our team - the anesthetist, the consultant general surgeon, the specialist registrar, the theatre sister, or myself had ever been to Sierra Leone before and no one knew what to expect, except that there was a declared cholera outbreak and it was the end of rainy season.
On arrival at the camp it was straight to work. We had to turn a couple of dusty disorganized rooms into an operating theatre, a pre-op assessment area and a post-op ward. It was clear this was going to be a team effort. The camp wasn’t due to open until our second day but there was a queue when we arrived and after a long clinic looking at unbelievably large hernias we filled up our operating list. The need was obvious. Most of our patients were manual laborers with years of heavy lifting behind them and the lack of preventative surgery contributed to the high prevalence of hernias, often untreated from birth.
Over the next few days we began operating and were struggling to get through our planned lists with the expected delays of an unfamiliar environment. Nevertheless patients kept turning up and it was evident that the demand for operations exceeded the number we were able to perform. We started to question our initial approach. Should we have booked patients on a first come first serve basis? The issue being that some people had to walk for days to attend camp and word had only reached distance villages after we started.
Would we have been better off booking smaller hernias and getting through more operations? We had started by prioritizing patients with large hernias whom we perceived to be in the greatest need of surgical intervention. But these operations were more complex, requiring longer operating times and with greater risk of complication. Then there were the patients who had attended previous camps with their medical notebooks documenting the hope of an operation if they returned this year. Should we have prioritised these patients?
We considered setting up another operating table in theatre and running two operations at once. But that wasn’t a practical solution and we had to face up to the difficult reality. We had to turn patients away, despite overwhelming medical need with it’s accompanying patient desperation. It was heartbreaking and against the instinct of a doctor, especially without a robust justification as to why one patient would be operated on over another.
In contrast to these frustrations, I found the way our team approached equipment shortages, time constraints and organisational challenges to be truly inspirational. None of us felt that we should compromise our UK standards just because we were in a developing country. We needed to operate as we would at home or not operate at all, and with this as our goal we found a way around each of our problems. We ran out of sterile drapes and thought we would need to cancel operations but improvised using patient gowns as sterile fields with make-shift holes cut into them. We developed a post-op scrotal support system made out of crepe bandages that we found more efficient than the expensive alternatives used in the UK. We rewired the diathermy machine into a health and safety hazard but fully functional piece of kit to prevent intraoperative bleeding. We conducted a group consent session to save precious operating time. And when the generator gave up one evening we used our head torches as operating lights and we treated an acute asthma attack using a polystyrene cup as spacer device instead of a nebulizer.
These innovations and many others provided a great sense of satisfaction. Outside the constraints of a large organization, in situations of overwhelming need, with limited resources, doctors are forced to be pragmatic to enable the show to go on. It is under these conditions that a doctor flourishes. Finding life saving solutions to problems and watching them implemented to enhance the life of another is central to why doctors choose the career they do. Nevertheless it is a feeling, perhaps, that we aren’t able to replicate in our day to day jobs where medical care is rightly protocol driven, innovations are less immediate and change is difficult to bring about. The normal response of a surgeon operating in suboptimal conditions is to go red in the face and get extremely frustrated with the system. In Sierra Leone suboptimal is the norm and finding innovative solutions is a necessity to the provision of safe medical care.
The difficulties our team shared over those ten days brought us together and created a strong team spirit, with a great sense of comradeship, equality and creativity that disregarded the fact we were all newly acquainted and was something I have rarely experience in my training as a doctor.
I don’t know if we prioritised the right patients. I dread to think of the fact that some of them will experience complications that we are no longer able to treat and I feel sorry for those patients we had to turn away. Thankfully, as a people, they graciously face hardship and show an appreciation which is unrivalled by patients in the UK. I would recommend the experience to anyone. There are multiple organizations that need doctors and other support staff to donate manageable amounts of there time to help provide a small amount of relief for the people who are less fortunate than ourselves. If I was you I’d sign up now.
Better Lives Foundation – Three 10 day camps a year with a need for medics, surgeons, dentists, anesthetists and general volunteers.
Operation Hernia – One 12 day camp a year with need for surgeons anesthetics and general volunteers.
United Planet – Multiple sites. Recruiting volunteers from a wide range of professions 2 weeks to 2 years.
Volunteers Overcoming Poverty – actively recruiting healthcare professionals in 2012 to a range of projects.
Like many doctors I have always wanted to work for an Non-Governmental Organisation (NGO) and help to provide medical care to people who need it most. Those of us who have looked into it have found that larger organisations like Medicines Sans Frontier require a minimum six-month commitment which can never normally fit in with our training or annual leave. Thus, many doctors never get a chance to scratch that itch.
But there is another way. I have just returned from a ten day visit to Sierra Leone. A small charity called the Better Lives Foundation runs three medical camps a year, in a small purpose built hospital 88 miles from Freetown in Yonibana.
Sierra Leone is one of the poorest African countries in terms of infrastructure; devastated by a ten year civil war that finished in 2002, there is virtually no clean water and electricity is scarce. The life expectancy is shockingly short at just 42 years and over 80% of medical care is provided by outside agencies.
I was going to take part in the Hernia camp and the goal was to perform thirty hernia operations in ten days with a team of doctors and nurses whom I met at Heathrow airport. None of our team - the anesthetist, the consultant general surgeon, the specialist registrar, the theatre sister, or myself had ever been to Sierra Leone before and no one knew what to expect, except that there was a declared cholera outbreak and it was the end of rainy season.
On arrival at the camp it was straight to work. We had to turn a couple of dusty disorganized rooms into an operating theatre, a pre-op assessment area and a post-op ward. It was clear this was going to be a team effort. The camp wasn’t due to open until our second day but there was a queue when we arrived and after a long clinic looking at unbelievably large hernias we filled up our operating list. The need was obvious. Most of our patients were manual laborers with years of heavy lifting behind them and the lack of preventative surgery contributed to the high prevalence of hernias, often untreated from birth.
Over the next few days we began operating and were struggling to get through our planned lists with the expected delays of an unfamiliar environment. Nevertheless patients kept turning up and it was evident that the demand for operations exceeded the number we were able to perform. We started to question our initial approach. Should we have booked patients on a first come first serve basis? The issue being that some people had to walk for days to attend camp and word had only reached distance villages after we started.
Would we have been better off booking smaller hernias and getting through more operations? We had started by prioritizing patients with large hernias whom we perceived to be in the greatest need of surgical intervention. But these operations were more complex, requiring longer operating times and with greater risk of complication. Then there were the patients who had attended previous camps with their medical notebooks documenting the hope of an operation if they returned this year. Should we have prioritised these patients?
We considered setting up another operating table in theatre and running two operations at once. But that wasn’t a practical solution and we had to face up to the difficult reality. We had to turn patients away, despite overwhelming medical need with it’s accompanying patient desperation. It was heartbreaking and against the instinct of a doctor, especially without a robust justification as to why one patient would be operated on over another.
In contrast to these frustrations, I found the way our team approached equipment shortages, time constraints and organisational challenges to be truly inspirational. None of us felt that we should compromise our UK standards just because we were in a developing country. We needed to operate as we would at home or not operate at all, and with this as our goal we found a way around each of our problems. We ran out of sterile drapes and thought we would need to cancel operations but improvised using patient gowns as sterile fields with make-shift holes cut into them. We developed a post-op scrotal support system made out of crepe bandages that we found more efficient than the expensive alternatives used in the UK. We rewired the diathermy machine into a health and safety hazard but fully functional piece of kit to prevent intraoperative bleeding. We conducted a group consent session to save precious operating time. And when the generator gave up one evening we used our head torches as operating lights and we treated an acute asthma attack using a polystyrene cup as spacer device instead of a nebulizer.
These innovations and many others provided a great sense of satisfaction. Outside the constraints of a large organization, in situations of overwhelming need, with limited resources, doctors are forced to be pragmatic to enable the show to go on. It is under these conditions that a doctor flourishes. Finding life saving solutions to problems and watching them implemented to enhance the life of another is central to why doctors choose the career they do. Nevertheless it is a feeling, perhaps, that we aren’t able to replicate in our day to day jobs where medical care is rightly protocol driven, innovations are less immediate and change is difficult to bring about. The normal response of a surgeon operating in suboptimal conditions is to go red in the face and get extremely frustrated with the system. In Sierra Leone suboptimal is the norm and finding innovative solutions is a necessity to the provision of safe medical care.
The difficulties our team shared over those ten days brought us together and created a strong team spirit, with a great sense of comradeship, equality and creativity that disregarded the fact we were all newly acquainted and was something I have rarely experience in my training as a doctor.
I don’t know if we prioritised the right patients. I dread to think of the fact that some of them will experience complications that we are no longer able to treat and I feel sorry for those patients we had to turn away. Thankfully, as a people, they graciously face hardship and show an appreciation which is unrivalled by patients in the UK. I would recommend the experience to anyone. There are multiple organizations that need doctors and other support staff to donate manageable amounts of there time to help provide a small amount of relief for the people who are less fortunate than ourselves. If I was you I’d sign up now.
Better Lives Foundation – Three 10 day camps a year with a need for medics, surgeons, dentists, anesthetists and general volunteers.
Operation Hernia – One 12 day camp a year with need for surgeons anesthetics and general volunteers.
United Planet – Multiple sites. Recruiting volunteers from a wide range of professions 2 weeks to 2 years.
Volunteers Overcoming Poverty – actively recruiting healthcare professionals in 2012 to a range of projects.
Thursday, September 27, 2012
The Power of Data – is it Right Hands, Right Time? Or Wrong Hands, Wrong Time? By Dr Thishi Surendranathan, Beacon UK
Can you imagine a healthcare system where doctors and other health professionals can access the totality of a patient's healthcare record online? Or where doctors and patients communicate via secure e-mail to help manage care outside the doctor's office? Or where doctors share data on their activity in real-time for the purposes of enhancing performance?
It already exists thanks to Kaiser Permanente, a not-for-profit health insurer and hospital chain based in California, United States. In this blogpost, I report back from a seminar-led by Kaiser Permanente's Murray Ross and Joy Lewis, and hosted by Reform in London on Wednesday 19th September.
For those of you clinicians and patients who are sceptical of taking home lessons from across the pond, where overall costs are horribly bloated by profit-making insurers and cherry-picking "fee-for-service" providers naming their price, I would advise you to pay closer attention to the high quality of its care, the level of patient satisfaction and the overall efficiency of the Kaiser Permanente operation.
For the fourth straight year, Kaiser Permanente is the only health plan in California to earn a 4-star rating - the highest possible - for overall quality of care by the California Office of the Patient Advocate, and has also achieved the highest possible rating for patient satisfaction. By virtue of its system of prepayment rather than fee-for-service, Kaiser has created a compelling model of integrated, high-quality, accessible health care.
As per Joy Lewis' introduction, Kaiser Permanente has 3 branches: a not-for-profit health plan, a not-for-profit community hospitals and 8 independent self-governed Permanente Medical Groups. With more than 7 million members in California alone and a further 2 million in 6 regions across the US, Kaiser serves a population greater than that of London.
Joy, who is Manager of Kaiser Permanente International, explained that the role of technology within the organisation is as an enabler, and nothing more. It's power depends on the users and the pervading cultures: without engagement from doctors the technology cannot be used to improve clinical effectiveness or improve the patient experience. It boils down to a simple equation:
Large new IT system + Old Organisation = Costly Old Organisation.
Could she have been referring to the NHS Programme for IT?
Murray Ross, Director of the Kaiser Permanente's Institute for Health Policy, went onto describe the role of data as one part of a triad of key components in Kaiser's success. These are:
1) Physician Leadership
2) Mindsets & Behaviours
3) Data & Reporting
The first part of the triad will be very interesting to those who are afraid that data will be used by managers as a malevolent tool to control doctors' behaviour. The overarching principle here is to preserve autonomy at the individual clinician level. Each of the medical groups providing care has an elected physician board i.e. the system relies on doctors leading other doctors. Promising leaders are identified early and each of these are given management training: further enhancing engagement of medical staff.
The second part of the triad refers to the culture of continuous improvement, knowledge-sharing and team-working that has enabled Kaiser to outperform its peers. Over decades, Kaiser has evolved a policy of pro-active, preventative, integrated care over reactive, fragmented care. The popularity of Kaiser amongst prospective physician recruits helps, there being a typical 10 applicants per post: Kaiser is able to pick and choose the most engaged and talented medics.
The last member of the triad is data and reporting. Over the past decade, Kaiser has spent over $4bn on an Electronic Health Record system developed by Epic. The most obvious benefit of this is that doctors can see ALL of their patients' medical information at the click of a few buttons: at the right place, at the right time. But just as useful to the organisation are the "matrix searches" possible on the vast amounts of data. Information can be pulled up by doctor, department, diagnosis and many other dimensions.
There a number of exciting consequences for this including:
Of these, the most anxiety-provoking for a British doctor may be the sharing of activity data "unblinded" amongst peers. However, the culture is not punitive, it is more about the development of good clinical practice. Doctors, who are usually all "A" students, naturally don't like coming last, so the mere sharing of data promotes competition by forcing doctors to simply ask: why? i.e. why am I different to those at the other end of the curve? The usual challenges include, "my patients are sicker" or "the data is wrong". Here it becomes especially important that Kaiser is built on physicians leading physicians. Outliers are recognised via a culture of openness and transparency, and, through discussion with and learning from their peers, those outliers improve their clinical practice.
Of course it would be difficult for the Kaiser Permanente model effectively provide high-quality, affordable care without appropriate alignment of incentives. Physicians working in the Kaiser system receive a 10% bonus if both the facility they work in and the individual physician achieves specific quality measures. There are no incentives based on volume, costs, utilisation or other financial measures. This idea is particularly relevant to NHS where the payment system mostly rewards activity.
The presentation closed with the observation that the affordability of latest health care reform in the United States was envisaged to depend on "delivery system reform", and the concurrent rise of the Accountable Care Organisation "...a group of physicians teamed with a hospital with joint responisbility for the quality and cost of care provided to a large (Medicare) population" as an alternative to lowering fee-for-service payment rates. This, according to Kaiser, is what they have already been doing for 60 years and, if successful, will change the way care is organised and delivered in the US.
It already exists thanks to Kaiser Permanente, a not-for-profit health insurer and hospital chain based in California, United States. In this blogpost, I report back from a seminar-led by Kaiser Permanente's Murray Ross and Joy Lewis, and hosted by Reform in London on Wednesday 19th September.
For those of you clinicians and patients who are sceptical of taking home lessons from across the pond, where overall costs are horribly bloated by profit-making insurers and cherry-picking "fee-for-service" providers naming their price, I would advise you to pay closer attention to the high quality of its care, the level of patient satisfaction and the overall efficiency of the Kaiser Permanente operation.
For the fourth straight year, Kaiser Permanente is the only health plan in California to earn a 4-star rating - the highest possible - for overall quality of care by the California Office of the Patient Advocate, and has also achieved the highest possible rating for patient satisfaction. By virtue of its system of prepayment rather than fee-for-service, Kaiser has created a compelling model of integrated, high-quality, accessible health care.
As per Joy Lewis' introduction, Kaiser Permanente has 3 branches: a not-for-profit health plan, a not-for-profit community hospitals and 8 independent self-governed Permanente Medical Groups. With more than 7 million members in California alone and a further 2 million in 6 regions across the US, Kaiser serves a population greater than that of London.
Joy, who is Manager of Kaiser Permanente International, explained that the role of technology within the organisation is as an enabler, and nothing more. It's power depends on the users and the pervading cultures: without engagement from doctors the technology cannot be used to improve clinical effectiveness or improve the patient experience. It boils down to a simple equation:
Large new IT system + Old Organisation = Costly Old Organisation.
Could she have been referring to the NHS Programme for IT?
Murray Ross, Director of the Kaiser Permanente's Institute for Health Policy, went onto describe the role of data as one part of a triad of key components in Kaiser's success. These are:
1) Physician Leadership
2) Mindsets & Behaviours
3) Data & Reporting
The first part of the triad will be very interesting to those who are afraid that data will be used by managers as a malevolent tool to control doctors' behaviour. The overarching principle here is to preserve autonomy at the individual clinician level. Each of the medical groups providing care has an elected physician board i.e. the system relies on doctors leading other doctors. Promising leaders are identified early and each of these are given management training: further enhancing engagement of medical staff.
The second part of the triad refers to the culture of continuous improvement, knowledge-sharing and team-working that has enabled Kaiser to outperform its peers. Over decades, Kaiser has evolved a policy of pro-active, preventative, integrated care over reactive, fragmented care. The popularity of Kaiser amongst prospective physician recruits helps, there being a typical 10 applicants per post: Kaiser is able to pick and choose the most engaged and talented medics.
The last member of the triad is data and reporting. Over the past decade, Kaiser has spent over $4bn on an Electronic Health Record system developed by Epic. The most obvious benefit of this is that doctors can see ALL of their patients' medical information at the click of a few buttons: at the right place, at the right time. But just as useful to the organisation are the "matrix searches" possible on the vast amounts of data. Information can be pulled up by doctor, department, diagnosis and many other dimensions.
There a number of exciting consequences for this including:
- the activity/behaviour of doctors can be measured against peers in real time
- care can be given proactively e.g. diabetes sufferers can be searched and all those requiring foot check/retinal screening/HbA1C check can be approached
- whole populations can be tracked/measured to develop screening programmes.
Of these, the most anxiety-provoking for a British doctor may be the sharing of activity data "unblinded" amongst peers. However, the culture is not punitive, it is more about the development of good clinical practice. Doctors, who are usually all "A" students, naturally don't like coming last, so the mere sharing of data promotes competition by forcing doctors to simply ask: why? i.e. why am I different to those at the other end of the curve? The usual challenges include, "my patients are sicker" or "the data is wrong". Here it becomes especially important that Kaiser is built on physicians leading physicians. Outliers are recognised via a culture of openness and transparency, and, through discussion with and learning from their peers, those outliers improve their clinical practice.
Of course it would be difficult for the Kaiser Permanente model effectively provide high-quality, affordable care without appropriate alignment of incentives. Physicians working in the Kaiser system receive a 10% bonus if both the facility they work in and the individual physician achieves specific quality measures. There are no incentives based on volume, costs, utilisation or other financial measures. This idea is particularly relevant to NHS where the payment system mostly rewards activity.
The presentation closed with the observation that the affordability of latest health care reform in the United States was envisaged to depend on "delivery system reform", and the concurrent rise of the Accountable Care Organisation "...a group of physicians teamed with a hospital with joint responisbility for the quality and cost of care provided to a large (Medicare) population" as an alternative to lowering fee-for-service payment rates. This, according to Kaiser, is what they have already been doing for 60 years and, if successful, will change the way care is organised and delivered in the US.
Monday, August 13, 2012
Internship at Bupa by Agneish Dutta, 5th year Medical Student, Imperial College London
I was most pleased to hear this summer that I had been accepted onto Bupa’s summer internship scheme for medical students, and equally daunted to learn that I was the first.
Setting out to work for the month I had off this summer, I began at Battle Bridge House, based in King’s Cross, having met my supervisors, Drs. Wai Keong Wong and Jenny Leeser at Bupa House, Holborn. I was struck by how friendly and enthusiastic everyone was to me, and I quickly settled in with my task. I spent the first two weeks conducting an audit with the aim of improving the way review appointments are made in occupational health. Working in this particular department allowed me to understand how workers of the railway are looked after, the prevalent health issues that affect this population and a whole new side to medicine that I would not have encountered through medical school alone. I had ample opportunity to sit in on clinics taken by technicians, nurses and doctors in equal measure. I took away a lot from my time spent talking to these staff and patients, which I am sure will enhance my development as a future healthcare professional.
The audit I conducted itself was an interesting insight into how the private healthcare insurance system works, and how practice is continually monitored to keep it efficient and cost effective. I was guided by Dr. Leeser through my tasks with prompt feedback, and was encouraged to write up my findings and procedure, which I would later present at a clinical governance meeting. Throughout my time at Bupa, such meetings were organised for me to be present at which revealed to me a commercial side of healthcare. I began to realise the challenges of the running of a private company, which in turn put into context the issues the NHS is now facing. It was a unique opportunity to hear from heads of different branches of the company and read the financial reports. They also had some delightful tea, a major perk.
Towards the end of my short time at Bupa, I visited centres around the country, including the highly impressive modern headquarters in Staines where I was privileged to sit in on some most intriguing work. Another trip took me to Manchester, specifically the Salford Quays where Bupa runs their remote health service. There I listened in on calls made and was told about how the department works. It gave me yet more of an idea of how healthcare is evolving; a cost effective service, and one I’m sure we will see in increasing use in all major healthcare services.
Throughout my time at Bupa I was helped whenever required, and plans were always made in advance. There was a good balance of using initiative and self learning and being taught new skills. I made friends and useful contacts in my time there. I feel very lucky to have had the opportunity to work at Bupa and miss it having returned to medical school! I sincerely recommend if you’re a medical student to apply, a thoroughly worthwhile and rewarding internship.
Setting out to work for the month I had off this summer, I began at Battle Bridge House, based in King’s Cross, having met my supervisors, Drs. Wai Keong Wong and Jenny Leeser at Bupa House, Holborn. I was struck by how friendly and enthusiastic everyone was to me, and I quickly settled in with my task. I spent the first two weeks conducting an audit with the aim of improving the way review appointments are made in occupational health. Working in this particular department allowed me to understand how workers of the railway are looked after, the prevalent health issues that affect this population and a whole new side to medicine that I would not have encountered through medical school alone. I had ample opportunity to sit in on clinics taken by technicians, nurses and doctors in equal measure. I took away a lot from my time spent talking to these staff and patients, which I am sure will enhance my development as a future healthcare professional.
The audit I conducted itself was an interesting insight into how the private healthcare insurance system works, and how practice is continually monitored to keep it efficient and cost effective. I was guided by Dr. Leeser through my tasks with prompt feedback, and was encouraged to write up my findings and procedure, which I would later present at a clinical governance meeting. Throughout my time at Bupa, such meetings were organised for me to be present at which revealed to me a commercial side of healthcare. I began to realise the challenges of the running of a private company, which in turn put into context the issues the NHS is now facing. It was a unique opportunity to hear from heads of different branches of the company and read the financial reports. They also had some delightful tea, a major perk.
Towards the end of my short time at Bupa, I visited centres around the country, including the highly impressive modern headquarters in Staines where I was privileged to sit in on some most intriguing work. Another trip took me to Manchester, specifically the Salford Quays where Bupa runs their remote health service. There I listened in on calls made and was told about how the department works. It gave me yet more of an idea of how healthcare is evolving; a cost effective service, and one I’m sure we will see in increasing use in all major healthcare services.
Throughout my time at Bupa I was helped whenever required, and plans were always made in advance. There was a good balance of using initiative and self learning and being taught new skills. I made friends and useful contacts in my time there. I feel very lucky to have had the opportunity to work at Bupa and miss it having returned to medical school! I sincerely recommend if you’re a medical student to apply, a thoroughly worthwhile and rewarding internship.
Thursday, July 26, 2012
"Calling drepreneurs everywhere - Healthbox are in town" by John Lee, Head of Operations for Clinical and Investigative Sciences at Imperial College Healthcare NHS Trust
I got a tip off about an interesting company, Healthbox, who are moving into the European Healthcare space. They have had a lot of success supporting small startups across the pond. I was intrigued so called up a couple of entrepreneurs, from podmetrics and destinationdoc, and wandered in to the dragons’ den in the city on Tuesday evening.
Boom - started with intense networking where ideas were flying all over the place; I heard about remote control elderly care, innovative rehab, find a doctor app, junior doctor handover apps to name but a few. There were a bunch of suits, trainer-wearing Mark Zuckerberg wanabees, techies, docs, academics and healthcare innovators. We had a quick drink before a brief informal, presentation about what Healthbox want to do in Europe.
Healthbox, along with its principal UK partners Serco and Bupa, intends to unleash innovation to make material improvements for patients, as quickly as possible. They will do so by helping enthusiasts translate our transformational ideas from the garage in their 2-up 2-down to the patient bedside. They will help us take ideas to marke and scale ideas much quicker than if we are left alone to make it work by ourselves. They do this by injecting cash, expert coaching from business gurus and through a strong tech network of potential customers.
Sounds good? Well this is not a charity exercise. There are some big names behind it who are interested in seeing a return on their investment. But I don't think that is something to be worried about - profit is not the reason d'être here. The market will speak for itself. If the idea solves an important healthcare issue it will sell and scale. So if the ideas are successful, investors will get their return, entrepreneurs get their lucky break, and ultimately, and most importantly, patients will get better care.
I think Healthbox are on to something here. In my experience, the majority of the best ideas in healthcare come from our clinicians and people working on the frontline. However these enthusiasts have to wade through ten tonnes of treacle to get anywhere and often lack the networks and know-how to spread ideas quickly. Unfortunately in the NHS, the door is so often closed before the idea can even be tested effectively. I hope that Healthbox, and other similar initiatives, will help our amazing individuals, and their ideas, thrive.
Healthbox's arrival in the UK is timely. It is clear that we are going to have an unprecedented time of austerity with four years of flat cash. With this in mind, the NHS needs some help - a message that came through again and again today at the inspirational Darzi fellows' 'Beyond the Bill' conference. Nick Seddon's outstanding contribution to a panel debate hailed the need for an entrepreneurial revolution. He recognised that 'necessity is the mother of invention', as such Nicholson's £20 billion challenge is opening the door for entrepreneurs to thrive.
Good luck to all those drpreneurs out there who are trying to break through. 2nd September is the deadline for this round of Healthbox: www.healthboxaccelerator.com
Boom - started with intense networking where ideas were flying all over the place; I heard about remote control elderly care, innovative rehab, find a doctor app, junior doctor handover apps to name but a few. There were a bunch of suits, trainer-wearing Mark Zuckerberg wanabees, techies, docs, academics and healthcare innovators. We had a quick drink before a brief informal, presentation about what Healthbox want to do in Europe.
Healthbox, along with its principal UK partners Serco and Bupa, intends to unleash innovation to make material improvements for patients, as quickly as possible. They will do so by helping enthusiasts translate our transformational ideas from the garage in their 2-up 2-down to the patient bedside. They will help us take ideas to marke and scale ideas much quicker than if we are left alone to make it work by ourselves. They do this by injecting cash, expert coaching from business gurus and through a strong tech network of potential customers.
Sounds good? Well this is not a charity exercise. There are some big names behind it who are interested in seeing a return on their investment. But I don't think that is something to be worried about - profit is not the reason d'être here. The market will speak for itself. If the idea solves an important healthcare issue it will sell and scale. So if the ideas are successful, investors will get their return, entrepreneurs get their lucky break, and ultimately, and most importantly, patients will get better care.
I think Healthbox are on to something here. In my experience, the majority of the best ideas in healthcare come from our clinicians and people working on the frontline. However these enthusiasts have to wade through ten tonnes of treacle to get anywhere and often lack the networks and know-how to spread ideas quickly. Unfortunately in the NHS, the door is so often closed before the idea can even be tested effectively. I hope that Healthbox, and other similar initiatives, will help our amazing individuals, and their ideas, thrive.
Healthbox's arrival in the UK is timely. It is clear that we are going to have an unprecedented time of austerity with four years of flat cash. With this in mind, the NHS needs some help - a message that came through again and again today at the inspirational Darzi fellows' 'Beyond the Bill' conference. Nick Seddon's outstanding contribution to a panel debate hailed the need for an entrepreneurial revolution. He recognised that 'necessity is the mother of invention', as such Nicholson's £20 billion challenge is opening the door for entrepreneurs to thrive.
Good luck to all those drpreneurs out there who are trying to break through. 2nd September is the deadline for this round of Healthbox: www.healthboxaccelerator.com
Monday, July 16, 2012
Workforce Planning Round Table with Reform, by Subashini M, Clinical Research Fellow at Department of Surgery at Imperial College
This meeting was held under the Chatham House Rules, hence neither the identity nor the affiliation of the speaker(s) nor that of any other participant can be revealed.
I was delighted to attend the discussion at Reform, an independent non-party think tank focused on public service delivery, on workforce planning. A group of 20 senior administrators, policy advisors and senior clinicians were invited to this roundtable discussion.
As a junior doctor, my interest was personal. Is there a light at the end of the training tunnel? We are all familiar with the anxiety and uncertainty facing junior doctors applying for specialty training and I was keen to find out how the current changes to healthcare service delivery model will affect doctors at the frontline.
The roundtable discussion commenced with the interesting fact that in the next 20 years, the number of people in England who are 65 and over is predicted to rise by 51% and the demands on our health and social care system will be very different. The key challenges brought up by this demographic shift were discussed in great detail. The term ‘horizon scanning’ was introduced. It was acknowledged that short-term cost-cutting does not and has not worked, hence the need to focus on long-term thinking; looking into probable futures in 15-20 years’ time. Although it is not possible to predict the impact of a potentially groundbreaking technology or life-saving drugs on workforce or the population, it is possible to postulate future healthcare needs with the Centre of Workforce Intelligence’s Horizon scanning system.
In order to meet the healthcare needs of the future, two main streams of solutions were identified. First was the less attractive and unpopular change in payment model, i.e. reviewing the range of services available free at point of delivery on the NHS. Second stream was to improve workforce motivation and efficiency. It was agreed that the second stream should be the focus at present to address the challenges highlighted.
Following on from that, the five habits to improve productivity in healthcare workforce were discussed. This was based on research performed by KPMG, titled ValueWalks. The detailed report is due to be published in autumn this year; an abbreviated version is available here
http://www.kpmg.com/UK/en/IssuesAndInsights/ArticlesPublications/Documents/PDF/Market%20Sector/Healthcare/preface-value-walks-june-2012.pdf
One of the habits outlined was mandatory training for clinicians in service re-design and business innovation. It was emphasised that clinical leadership and engagement is essential for re-modelling care. The common practice of successful healthcare teams around the world was to look at the precise aspects of care and to continuously improve each micro-process. In order for this practice to be adopted, staff had to be empowered. This, in turn, improves efficiency.
There was also discussion about the shift of healthcare delivery from hospital-based care to community-based care and doctor-led to nurse-led care. Although one of the driving forces is cost, this model has been noted to be successful in other countries. It was felt that task shifting and blurring the boundaries of healthcare workforce was another way to maximise the efficiency of the current staff.
There were several radical and thought-provoking ideas brought up during the discussion. Although there was consensus regarding the real and present challenges faced by the NHS, there was no panacea for this issue. Each professional group (providers, analysts and clinicians) had different ideas of how to rectify this issue. One of the guests described the current situation as a ‘perfect storm’, which was the perfect opportunity for us all to get back to the drawing board and innovate a solution to heal our NHS.
I came away from the meeting with several thoughts. However, most importantly, I felt that it is crucial for junior doctors to be acutely aware of the changing shape of healthcare. It must be emphasised that clinical leadership and interest in service design and delivery are important, yet often over-looked areas of professional development. The traditional role of doctoring and hospital-based care structure are changing and we should use this as an opportunity to re-align ourselves to fit into this brave new world of healthcare of the future.
I was delighted to attend the discussion at Reform, an independent non-party think tank focused on public service delivery, on workforce planning. A group of 20 senior administrators, policy advisors and senior clinicians were invited to this roundtable discussion.
As a junior doctor, my interest was personal. Is there a light at the end of the training tunnel? We are all familiar with the anxiety and uncertainty facing junior doctors applying for specialty training and I was keen to find out how the current changes to healthcare service delivery model will affect doctors at the frontline.
The roundtable discussion commenced with the interesting fact that in the next 20 years, the number of people in England who are 65 and over is predicted to rise by 51% and the demands on our health and social care system will be very different. The key challenges brought up by this demographic shift were discussed in great detail. The term ‘horizon scanning’ was introduced. It was acknowledged that short-term cost-cutting does not and has not worked, hence the need to focus on long-term thinking; looking into probable futures in 15-20 years’ time. Although it is not possible to predict the impact of a potentially groundbreaking technology or life-saving drugs on workforce or the population, it is possible to postulate future healthcare needs with the Centre of Workforce Intelligence’s Horizon scanning system.
In order to meet the healthcare needs of the future, two main streams of solutions were identified. First was the less attractive and unpopular change in payment model, i.e. reviewing the range of services available free at point of delivery on the NHS. Second stream was to improve workforce motivation and efficiency. It was agreed that the second stream should be the focus at present to address the challenges highlighted.
Following on from that, the five habits to improve productivity in healthcare workforce were discussed. This was based on research performed by KPMG, titled ValueWalks. The detailed report is due to be published in autumn this year; an abbreviated version is available here
http://www.kpmg.com/UK/en/IssuesAndInsights/ArticlesPublications/Documents/PDF/Market%20Sector/Healthcare/preface-value-walks-june-2012.pdf
One of the habits outlined was mandatory training for clinicians in service re-design and business innovation. It was emphasised that clinical leadership and engagement is essential for re-modelling care. The common practice of successful healthcare teams around the world was to look at the precise aspects of care and to continuously improve each micro-process. In order for this practice to be adopted, staff had to be empowered. This, in turn, improves efficiency.
There was also discussion about the shift of healthcare delivery from hospital-based care to community-based care and doctor-led to nurse-led care. Although one of the driving forces is cost, this model has been noted to be successful in other countries. It was felt that task shifting and blurring the boundaries of healthcare workforce was another way to maximise the efficiency of the current staff.
There were several radical and thought-provoking ideas brought up during the discussion. Although there was consensus regarding the real and present challenges faced by the NHS, there was no panacea for this issue. Each professional group (providers, analysts and clinicians) had different ideas of how to rectify this issue. One of the guests described the current situation as a ‘perfect storm’, which was the perfect opportunity for us all to get back to the drawing board and innovate a solution to heal our NHS.
I came away from the meeting with several thoughts. However, most importantly, I felt that it is crucial for junior doctors to be acutely aware of the changing shape of healthcare. It must be emphasised that clinical leadership and interest in service design and delivery are important, yet often over-looked areas of professional development. The traditional role of doctoring and hospital-based care structure are changing and we should use this as an opportunity to re-align ourselves to fit into this brave new world of healthcare of the future.
Sunday, July 8, 2012
Diagnosis Salon with the Trainee Group of FMLM on 27th June 2012 - What is the value of value? by Dr Nisha Mehta NIHR Academic Clinical Fellow in Psychiatry at King's College London
It was a real pleasure to attend yet another lively and educational Diagnosis Salon where a nuanced and informative debate was enjoyed by all who attended. Co-hosted with the Faculty of Medical Leadership and Management, we were treated to a panel of experienced speakers put together by the Diagnosis team.
Speaking broadly in favour of the concept of value we heard Dr Rupert Dunbar-Rees and Dr Emma Stanton encourage us to reflect on the ways in which we can get maximum 'value' out of each stage of the health supply chain, which includes efficiency, focus, drive and team working.
Emma drew some fascinating parallels with her time sailing round the world in a yacht race, comparing this to her current NHS work as a neuropsychiatrist hearing about the inefficiencies in a system that causes frustration to staff and patients on a daily basis within the NHS.
The debate hotted up with a contribution from Dr Peter Lachman who suggested that the word 'value' is perhaps bandied about too freely and in such a loosely defined way as not to be entirely helpful to the healthcare debate in its current form. Peter worried that the use of the term 'value' is code for 'cost cutting' and suggested that it is important not to allow this to happen, because combined with competition and free market forces in health we risk eroding the values of the NHS.
Harvard Business School's Michael Porter's controversial 'value in healthcare' paper was discussed during Dr Anas El-Turabi's talk, in which he suggested that although they contain some merit, Porter's ideas for value in healthcare do not correspond to the corporate model from which his concept of 'value' originates through a failure to build in sustainability and factor in equity in the model. This opened up the debate to the floor nicely - from which point we heard several excellent arguments from the audience.
These included a discussion about whether the new 'value' agenda is simply a re-hashing of the pre-recession 'quality' agenda. We also heard an interesting debate about the exact definitions of 'value' and the role of cost, quality, supply chain, health services organisation in all of this.
I had recently had a very interesting discussion with Professor Uwe Reinhardt, Professor of Political Economy and Economics at Stanford University, that any discussion about value ought to take into account the value system of the health service in question - whether this be free market, egalitarian or somewhere in between - given that this will have a clear impact on the 'value' that any given society places on a life. This reflection seems to chime with the theme of the evening - that 'value' is a multi layered, complex phenomenon within healthcare, and that definitions are important, as are practical applications of the theory and concept.
Value seems here to stay (whether we like it or not!) and it cannot be ignored. I was thrilled that the Diagnosis Salon gave me a great opportunity to crystallise my own thinking on the subject and that it has inspired me to find out more! Thanks very much to the Diagnosis team for all their hard work and looking forward to the next Salon!
Speaking broadly in favour of the concept of value we heard Dr Rupert Dunbar-Rees and Dr Emma Stanton encourage us to reflect on the ways in which we can get maximum 'value' out of each stage of the health supply chain, which includes efficiency, focus, drive and team working.
Emma drew some fascinating parallels with her time sailing round the world in a yacht race, comparing this to her current NHS work as a neuropsychiatrist hearing about the inefficiencies in a system that causes frustration to staff and patients on a daily basis within the NHS.
The debate hotted up with a contribution from Dr Peter Lachman who suggested that the word 'value' is perhaps bandied about too freely and in such a loosely defined way as not to be entirely helpful to the healthcare debate in its current form. Peter worried that the use of the term 'value' is code for 'cost cutting' and suggested that it is important not to allow this to happen, because combined with competition and free market forces in health we risk eroding the values of the NHS.
Harvard Business School's Michael Porter's controversial 'value in healthcare' paper was discussed during Dr Anas El-Turabi's talk, in which he suggested that although they contain some merit, Porter's ideas for value in healthcare do not correspond to the corporate model from which his concept of 'value' originates through a failure to build in sustainability and factor in equity in the model. This opened up the debate to the floor nicely - from which point we heard several excellent arguments from the audience.
These included a discussion about whether the new 'value' agenda is simply a re-hashing of the pre-recession 'quality' agenda. We also heard an interesting debate about the exact definitions of 'value' and the role of cost, quality, supply chain, health services organisation in all of this.
I had recently had a very interesting discussion with Professor Uwe Reinhardt, Professor of Political Economy and Economics at Stanford University, that any discussion about value ought to take into account the value system of the health service in question - whether this be free market, egalitarian or somewhere in between - given that this will have a clear impact on the 'value' that any given society places on a life. This reflection seems to chime with the theme of the evening - that 'value' is a multi layered, complex phenomenon within healthcare, and that definitions are important, as are practical applications of the theory and concept.
Value seems here to stay (whether we like it or not!) and it cannot be ignored. I was thrilled that the Diagnosis Salon gave me a great opportunity to crystallise my own thinking on the subject and that it has inspired me to find out more! Thanks very much to the Diagnosis team for all their hard work and looking forward to the next Salon!
Saturday, June 30, 2012
Elective in Health Policy by Edward Maile, Academic Foundation Doctor, Oxford University Clinical Academic Graduate School
I have been interested in health policy, public health and medical leadership since the start of medical school and this interest deepened after reading books by Atul Gawande (www.gawande.com), a surgeon and public health researcher. I felt that discussion of population-level approaches to healthcare delivery was lacking during my undergraduate degree. This is understandable in the context of an intensive course where producing safe junior doctors who can interact effectively with individual patients is the priority. With this in mind, when presented with the blank canvas that is the elective period it represented a golden opportunity to find out more about public health.
Harvard School of Public Health is one of the world-leading centres for public health. Therefore I set about emailing doctors there and eventually, with the help of Diagnosis' Dr. Emma Stanton, arranged a placement. This was a fantastic experience. I worked as part of a multidisciplinary team whose focus was to analyse health services and provision of care which exposed me to core disciplines of public health such as epidemiology and biostatistics. My role was to collect data on recent US health policy changes and to work with statisticians and physicians on analysis and interpretation. Additionally, I spent time with a cardiologist which provided front line context for my experience of public health. The facilities in Boston are hugely impressive but exist in a system which, like many others, faces challenges of equity of access to health services.
A particular personal highlight was the opportunity to attend seminars and conferences dealing with public health, policy, leadership and management. Speakers included Elliot Fisher, a key thinker behind the concept of Accountable Care Organisations which are an important feature of the Affordable Care Act. I also heard Gary Gottlieb speak, President and CEO of Partners which is one of the leading non-profit healthcare systems in the USA, as well as Lucian Leape, a pioneer and international leader of the patient safety movement and Joseph Newhouse, a distinguished health economist. I was able to visit the Institute for Healthcare Improvement (www.ihi.org) in Cambridge to learn about Quality Improvement (QI) and the IHI Open School which offers online courses in QI including a practicum element which walks learners through their own QI project.
There were many learning points which I took back to the UK. It was particularly interesting to observe the strong culture of medically-qualified leadership in the US, in contrast to the UK where many managers and CEOs don't have a clinical background. This led me to consider how I might develop my own management skills. I also noted a strong "can-do" attitude in the US, where no challenge is too large. I intend to retain this sentiment as I begin life as a doctor. My interests in public health, policy and medical leadership are still coalescing but I left HSPH feeling inspired, motivated and determined to learn more. I would highly recommend visiting HSPH to anyone that has the opportunity.
Harvard School of Public Health is one of the world-leading centres for public health. Therefore I set about emailing doctors there and eventually, with the help of Diagnosis' Dr. Emma Stanton, arranged a placement. This was a fantastic experience. I worked as part of a multidisciplinary team whose focus was to analyse health services and provision of care which exposed me to core disciplines of public health such as epidemiology and biostatistics. My role was to collect data on recent US health policy changes and to work with statisticians and physicians on analysis and interpretation. Additionally, I spent time with a cardiologist which provided front line context for my experience of public health. The facilities in Boston are hugely impressive but exist in a system which, like many others, faces challenges of equity of access to health services.
A particular personal highlight was the opportunity to attend seminars and conferences dealing with public health, policy, leadership and management. Speakers included Elliot Fisher, a key thinker behind the concept of Accountable Care Organisations which are an important feature of the Affordable Care Act. I also heard Gary Gottlieb speak, President and CEO of Partners which is one of the leading non-profit healthcare systems in the USA, as well as Lucian Leape, a pioneer and international leader of the patient safety movement and Joseph Newhouse, a distinguished health economist. I was able to visit the Institute for Healthcare Improvement (www.ihi.org) in Cambridge to learn about Quality Improvement (QI) and the IHI Open School which offers online courses in QI including a practicum element which walks learners through their own QI project.
There were many learning points which I took back to the UK. It was particularly interesting to observe the strong culture of medically-qualified leadership in the US, in contrast to the UK where many managers and CEOs don't have a clinical background. This led me to consider how I might develop my own management skills. I also noted a strong "can-do" attitude in the US, where no challenge is too large. I intend to retain this sentiment as I begin life as a doctor. My interests in public health, policy and medical leadership are still coalescing but I left HSPH feeling inspired, motivated and determined to learn more. I would highly recommend visiting HSPH to anyone that has the opportunity.
Sunday, June 17, 2012
Leadership for Improvement: The Kings Fund Seminar 22nd May 2012 – by Rebecca Minton, Clinical Leadership Fellow & Psychological Therapist
I had the privilege of attending a fantastic seminar hosted by The Kings Fund on ‘Leadership for Improvement.’ The event brought together 80 key names in the field of healthcare leadership and we heard talks from four experienced and inspiring leaders.
Maureen Bisognano, President and CEO for IHI presented three inspiring case studies where applying ‘improvement science’ led to better patient care and improved outcomes at a lower cost. One example: Southcentral Foundation’s Nuka model of care – designed with the Alaskan population at the heart – listening to their views, designing a system around their values and preferences, providing integrated health and social care, and focusing on wellbeing rather than disease. Can the NHS do more of this? And should ‘improvement science’ be included in clinical training? – the majority of the roundtable believed so. Maureen Bisognano said clinicians have two roles: clinical work and improving care. Would all clinicians agree? I do! The IHI holds R&D days where staff are given problems to solve in order to learn new ways to use improvement science – could the NHS adopt this too?
David Fillingham, CEO of AQuA, stated that successful leaders need technical know-how, improvement know-how, and personal effectiveness to achieve results, not hierarchical power. He also stressed the importance of having the time and headroom to develop these skills, and career opportunities structured for breadth, not just depth, gaining learning from elsewhere (the Diagnosis Intern Network perhaps!?)
Bettina Fitt, General Manager at GE Healthcare, talked about the open, collaborative, ‘we’ culture where staff engagement is key, leaders inspire and listen to their staff, and results from staff opinion surveys are used to drive performance.
Professor Richard Bohmer promoted the need for clinical leadership and emphasised that clinical leadership is: a) respectable and b) work - so needs to be valued (yeh!).
So key points to take away:
- Communicate purpose and model leadership behaviours
- Talk about tomorrow not today
- Focus on how problems can be prevented rather than solved
- Learn from the voices of patients
- Step outside the walls of the hospital
- Look outside and understand the real needs of the population
- Engage and listen to others
- Use improvement science (or learn it first!)
>br>
It was very exciting to be in a room with so many great people and hear everyone speak so passionately about leadership. I feel very privileged to have had this opportunity to hear the knowledge and wisdom of respected healthcare leaders from across the world (thanks for the invite Emma!). It was great to hear that they want to encourage and learn from young emerging leaders and I’m now even more inspired in my role as a new clinical leader. Now I can’t wait to tell my cohort of clinical leadership fellows all about it!...
Maureen Bisognano, President and CEO for IHI presented three inspiring case studies where applying ‘improvement science’ led to better patient care and improved outcomes at a lower cost. One example: Southcentral Foundation’s Nuka model of care – designed with the Alaskan population at the heart – listening to their views, designing a system around their values and preferences, providing integrated health and social care, and focusing on wellbeing rather than disease. Can the NHS do more of this? And should ‘improvement science’ be included in clinical training? – the majority of the roundtable believed so. Maureen Bisognano said clinicians have two roles: clinical work and improving care. Would all clinicians agree? I do! The IHI holds R&D days where staff are given problems to solve in order to learn new ways to use improvement science – could the NHS adopt this too?
David Fillingham, CEO of AQuA, stated that successful leaders need technical know-how, improvement know-how, and personal effectiveness to achieve results, not hierarchical power. He also stressed the importance of having the time and headroom to develop these skills, and career opportunities structured for breadth, not just depth, gaining learning from elsewhere (the Diagnosis Intern Network perhaps!?)
Bettina Fitt, General Manager at GE Healthcare, talked about the open, collaborative, ‘we’ culture where staff engagement is key, leaders inspire and listen to their staff, and results from staff opinion surveys are used to drive performance.
Professor Richard Bohmer promoted the need for clinical leadership and emphasised that clinical leadership is: a) respectable and b) work - so needs to be valued (yeh!).
So key points to take away:
- Communicate purpose and model leadership behaviours
- Talk about tomorrow not today
- Focus on how problems can be prevented rather than solved
- Learn from the voices of patients
- Step outside the walls of the hospital
- Look outside and understand the real needs of the population
- Engage and listen to others
- Use improvement science (or learn it first!)
>br>
It was very exciting to be in a room with so many great people and hear everyone speak so passionately about leadership. I feel very privileged to have had this opportunity to hear the knowledge and wisdom of respected healthcare leaders from across the world (thanks for the invite Emma!). It was great to hear that they want to encourage and learn from young emerging leaders and I’m now even more inspired in my role as a new clinical leader. Now I can’t wait to tell my cohort of clinical leadership fellows all about it!...
Monday, May 28, 2012
Diagnosis Salon 28 February 2012: A Panel of Policy Pundits by Dr Paul Rutter
Diagnosis Salons are usually convivial gatherings, meetings of people who are all singing from the same Clinical Leadership hymn sheet. Tonight didn’t feel quite like that. Brought together in the Kings Fund basement were 60 or so Diagnosers, the Prime Minister’s health advisor, a deputy director of the think tank Reform, and me. We were there to talk health policy. I attempted to raise some interest in discussing global health policy, but it was difficult. A mile down the road from us, the Lords were debating the Health & Social Care Bill. Global health wouldn’t get much of a look-in. A fierce debate about NHS reform was clearly the order of the day.
As we chewed over one issue after another, the tension started to clear and we found ourselves airing a rich debate. A debate far more nuanced than was being heard across most of the NHS. We started off a bit polarised: ‘private sector = evil’ versus ‘private sector = efficient, innovative, answer to our prayers’. NHS reorganization is such a controversial and emotional issue that it is easy to default to over-simplistic debate. We managed to get away from this quite quickly. What do we actually think about issues like competition? As individuals, don’t we want to be able to choose to see to a GP who we know is good, even if it’s a bit of a drive? But does this argument really work with hospitals when – outside of London at least – convenience has a lot more to do with it? And what do we think about politics and the NHS anyway? The traditional complaint is that politicians should just stop interfering. But at least the arrangement means that somebody is accountable to the population for the NHS, in a way that systems elsewhere in the world are not. And what about the independent sector? Not to be trusted? Why? And aren’t GPs independent contractors anyway? And have you heard about Circle, the company that now runs an NHS hospital, owned half by City investors and half by doctors, nurses and other healthcare staff? What on earth do we make of that?
As the evening progressed, more shades of grey emerged, concessions were made. And we acknowledged that we – and most people in the NHS – had not had enough of this kind of grown-up debate. Somehow the Health & Social Care bill had almost been passed, and what we had mainly been surrounded by was anger, vitriol, and less-than-complete understanding on all sides of the debate. And of course, it is not as if there was just a single debate: it is difficult to be for or against everything in the Health & Social Care Bill.
I couldn’t say that we all left the room speaking with one voice, arm-in-arm, the problems of the world put to rest. But that there was perceptibly more mutual understanding than when we started, more acknowledgment of the complexities, more appreciation of the alternative perspective. Most still left the room feeling overall that Andrew Lansley was doing a terrible thing to our NHS. The majority were particularly upset that he felt the need for structural reorganisation, when most of the Bill’s aims could have been achieved without it. And why didn’t he communicate properly before he pulled this out of his back pocket? But there was a stronger collective conclusion: that surely more of this engaged debate between clinicians and policy makers would be a good thing.
So that’s the challenge to all of us doctors and other Diagnosers: the next time a Health Secretary pulls a shiny new Bill from their pocket, let’s do better. Whether it’s a good shiny new plan or a bad shiny new plan, let’s get ourselves faster to a position of informed and intelligent debate than we did this time round.
As we chewed over one issue after another, the tension started to clear and we found ourselves airing a rich debate. A debate far more nuanced than was being heard across most of the NHS. We started off a bit polarised: ‘private sector = evil’ versus ‘private sector = efficient, innovative, answer to our prayers’. NHS reorganization is such a controversial and emotional issue that it is easy to default to over-simplistic debate. We managed to get away from this quite quickly. What do we actually think about issues like competition? As individuals, don’t we want to be able to choose to see to a GP who we know is good, even if it’s a bit of a drive? But does this argument really work with hospitals when – outside of London at least – convenience has a lot more to do with it? And what do we think about politics and the NHS anyway? The traditional complaint is that politicians should just stop interfering. But at least the arrangement means that somebody is accountable to the population for the NHS, in a way that systems elsewhere in the world are not. And what about the independent sector? Not to be trusted? Why? And aren’t GPs independent contractors anyway? And have you heard about Circle, the company that now runs an NHS hospital, owned half by City investors and half by doctors, nurses and other healthcare staff? What on earth do we make of that?
As the evening progressed, more shades of grey emerged, concessions were made. And we acknowledged that we – and most people in the NHS – had not had enough of this kind of grown-up debate. Somehow the Health & Social Care bill had almost been passed, and what we had mainly been surrounded by was anger, vitriol, and less-than-complete understanding on all sides of the debate. And of course, it is not as if there was just a single debate: it is difficult to be for or against everything in the Health & Social Care Bill.
I couldn’t say that we all left the room speaking with one voice, arm-in-arm, the problems of the world put to rest. But that there was perceptibly more mutual understanding than when we started, more acknowledgment of the complexities, more appreciation of the alternative perspective. Most still left the room feeling overall that Andrew Lansley was doing a terrible thing to our NHS. The majority were particularly upset that he felt the need for structural reorganisation, when most of the Bill’s aims could have been achieved without it. And why didn’t he communicate properly before he pulled this out of his back pocket? But there was a stronger collective conclusion: that surely more of this engaged debate between clinicians and policy makers would be a good thing.
So that’s the challenge to all of us doctors and other Diagnosers: the next time a Health Secretary pulls a shiny new Bill from their pocket, let’s do better. Whether it’s a good shiny new plan or a bad shiny new plan, let’s get ourselves faster to a position of informed and intelligent debate than we did this time round.
Sunday, May 13, 2012
Internship with HSJ (Health Services Journal) by Irfan (Barts and The London Medical School)
The HSJ is the leading journal on healthcare policy news and resources in the UK. The internship is a fantastic way for medical students to really understand the changes that are taking place in the NHS, now and in the next few years, which will affect their working lives as doctors. Unfortunately, the medical school curriculum places little emphasis on the leadership, managerial and resource allocation skills that doctors will need to have in the future, to deliver both a clinically effective and cost effective standard of care.
From getting published 3 times in the Journal, to going to the House of Lords for a Health Select Committee Review and interviewing individual who are making high-level decisions about the future of the NHS, my time at HSJ was extremely enjoyable to put it mildly. It was an opportunity to learn different skill sets and knowledge and enjoy life away from medicine for a while.
For most part, what you get out of this internship is what you put in. There are opportunities to spend time on research, writing and the business sides of publishing.
I started my internship just as the Healthcare Reforms were going through the House of Lords, and this made the experience even more relevant, as the insight and commentary of team members made for interesting discussion about the future of the NHS.
One aspect I really enjoy was the responsibility given from day one, by the Editor, Alastair McLellan. I will never forget the moment he came to my desk and asked me to write a story about clinical negligence on my 2nd day at the office. After some investigatory work, I had my news angle and with the guidance of the other journalist, I management to get an interview with the CEO of the NHSLA and wrote my first journalistic piece, which I will look back on with pride.
The team were extremely friendly and had vast expertise on health care service and policy. They are always willing to answer any questions and explain the background in any discussions the team were having. The debates around policy issues were great to partake in and even picking up knowledge nuggets through listening in was fantastic. In a very short space of time I was fully aware of numerous topics in healthcare, which are never taught in medical school, such as commissioning, organisational structure, salaries and pension and the role of private initiatives.
I would thoroughly recommend this internship for any medical student who really wants to understand healthcare policy and the connection between policy markers and clinicians. For those individuals who have a flair for writing, this is the perfect place to hone your skills and understand what medical journalism is all about.
From getting published 3 times in the Journal, to going to the House of Lords for a Health Select Committee Review and interviewing individual who are making high-level decisions about the future of the NHS, my time at HSJ was extremely enjoyable to put it mildly. It was an opportunity to learn different skill sets and knowledge and enjoy life away from medicine for a while.
For most part, what you get out of this internship is what you put in. There are opportunities to spend time on research, writing and the business sides of publishing.
I started my internship just as the Healthcare Reforms were going through the House of Lords, and this made the experience even more relevant, as the insight and commentary of team members made for interesting discussion about the future of the NHS.
One aspect I really enjoy was the responsibility given from day one, by the Editor, Alastair McLellan. I will never forget the moment he came to my desk and asked me to write a story about clinical negligence on my 2nd day at the office. After some investigatory work, I had my news angle and with the guidance of the other journalist, I management to get an interview with the CEO of the NHSLA and wrote my first journalistic piece, which I will look back on with pride.
The team were extremely friendly and had vast expertise on health care service and policy. They are always willing to answer any questions and explain the background in any discussions the team were having. The debates around policy issues were great to partake in and even picking up knowledge nuggets through listening in was fantastic. In a very short space of time I was fully aware of numerous topics in healthcare, which are never taught in medical school, such as commissioning, organisational structure, salaries and pension and the role of private initiatives.
I would thoroughly recommend this internship for any medical student who really wants to understand healthcare policy and the connection between policy markers and clinicians. For those individuals who have a flair for writing, this is the perfect place to hone your skills and understand what medical journalism is all about.
Sunday, May 6, 2012
Internship with KPMG by Assad Farooq, Medical Student at Imperial College
I started my elective in Healthcare Management with KPMG with a scholarly apprehension. Scholarly apprehension because I graduated from the Imperial College Business School with an Intercalated BSc in Healthcare Management, but anxious all the while about the unknown. That unknown lies at the heart of management consulting. The unknown represents unprecedented contingencies, strict performance targets and sometimes unchartered territories. These factors force the consulting mind to think about creative solutions, exercise disciplined project management and to collaborate with colleagues to leverage each others expertise. This was a challenge and yet an attraction all the while. And, this was the essence of consulting for me.
I traded my stethoscope for a suit and I was immediately made to feel a valued and important part of my team. I attended meetings with supervisors and immediate colleagues who all embraced my learning needs and provided a clear direction about my role and responsibilities in each project. I was given the privilege to work on the ground as well as being invited to attend senior meetings concerning overall strategy. This gave me a 360 degree perspective about project management and helped me to understand the extent of collaboration required to provide the optimum solution to clients. I was involved in three projects ranging from operations management to GP commissioning and risk management.
KPMG is an institution that prides itself on their renowned training schemes. As a medical student intern you are monitored closely and provided with constant support. I was kindly paired with two colleagues who were my mentors and provided me with constant advice. This helped me in both an academic sense and in understanding the wider corporate culture. I developed a close relationship with the mentors I had the privilege of meeting and will contact them well into the future for advice in my future career! This was complemented by a number of internal courses that I completed through the KPMG Business School. These provided me with a sound foundation about the important skills and theory before I embarked on my projects.
Doctors are being encouraged to develop refreshing and bold service-level strategies by taking the helms of health care management and embracing clinical leadership.
Medical students rarely get the opportunity to embark on such ambitious internships. This opportunity has given me a fresh outlook on the challenges we face as future clinicians and got my mind overflowing with innovative solutions to many of the problems currently faced by the NHS. It was an honour to work on exciting, demanding and high-level healthcare management projects, and being a student of the most-respected and experienced leaders in these fields.
I would especially like to extend my ceaseless gratitude to Professor Hillary Thomas, Mr. John Howard, Mr. Russ Jewell, Mr. Hugh Neylan and Dr. Helena Posnett for accepting me into there dynamic team and Dr. Harpreet Sood at the Diagnosis Internship Network for making this possible and for his kind supervision throughout.
I traded my stethoscope for a suit and I was immediately made to feel a valued and important part of my team. I attended meetings with supervisors and immediate colleagues who all embraced my learning needs and provided a clear direction about my role and responsibilities in each project. I was given the privilege to work on the ground as well as being invited to attend senior meetings concerning overall strategy. This gave me a 360 degree perspective about project management and helped me to understand the extent of collaboration required to provide the optimum solution to clients. I was involved in three projects ranging from operations management to GP commissioning and risk management.
KPMG is an institution that prides itself on their renowned training schemes. As a medical student intern you are monitored closely and provided with constant support. I was kindly paired with two colleagues who were my mentors and provided me with constant advice. This helped me in both an academic sense and in understanding the wider corporate culture. I developed a close relationship with the mentors I had the privilege of meeting and will contact them well into the future for advice in my future career! This was complemented by a number of internal courses that I completed through the KPMG Business School. These provided me with a sound foundation about the important skills and theory before I embarked on my projects.
Doctors are being encouraged to develop refreshing and bold service-level strategies by taking the helms of health care management and embracing clinical leadership.
Medical students rarely get the opportunity to embark on such ambitious internships. This opportunity has given me a fresh outlook on the challenges we face as future clinicians and got my mind overflowing with innovative solutions to many of the problems currently faced by the NHS. It was an honour to work on exciting, demanding and high-level healthcare management projects, and being a student of the most-respected and experienced leaders in these fields.
I would especially like to extend my ceaseless gratitude to Professor Hillary Thomas, Mr. John Howard, Mr. Russ Jewell, Mr. Hugh Neylan and Dr. Helena Posnett for accepting me into there dynamic team and Dr. Harpreet Sood at the Diagnosis Internship Network for making this possible and for his kind supervision throughout.
Sunday, April 29, 2012
From medicine to management consulting – life on the other side
Five years ago I resigned from a radiology number in London to become a management consultant at a large strategy consulting firm. One of the many implications of this has been that most people – particularly medics – have absolutely no idea what I do for a living any more. I've been promising Claire and Emma that I'd do my best to explain what it means for over a year now, and so with apologies for the long delay, here is my best attempt.
One of the reasons that people find the whole concept baffling is that the consulting industry varies hugely from firm to firm and project to project. Consultancies come in all shapes and sizes – specialist, generalist, small, large, local, global – and each project a firm does will be different to the last one – in a different industry, for a different company, with a different team, for a different reason. Even within healthcare, projects can range from redesigning manufacturing at a large pharmaceutical company to improving patient safety at an NHS trust. However, in its most basic form, consulting has many parallels to medicine. Companies have many ailments (currently they mostly have costs) and consultancies find ways of making them better. At its worst it involves spending a lot of money for no discernible improvement, but often it can help overcome difficult problems with the benefit of an external perspective and additional manpower.
On a personal level, becoming a management consultant has offered me a whole new perspective on the world - many doctors are fairly business minded but I really wasn't, and so for me it has been transforming. I read The Economist, recognise supermarket pricing strategies targeted at me, and have coherent conversations about my mortgage interest rates. Importantly, I also see healthcare differently. I understand the debate about finite funding and expanding demand, about how outcomes tend to be better with centralisation but nobody wants to close their local hospital, about tariffs, PCTs, SHAs, CCGs and all manner of three letter acronyms so beloved of the NHS. I also recognise the importance of having medics who understand management in the system (and indeed, managers who understand medics), instead of viewing them with deep scepticism. Many are finding flexible ways of balancing their management, leadership and clinical aspirations - they attend Diagnosis Salons, participate in SHA leadership schemes, and follow role models like Claire and Emma down an alternative path. I think back to the angry junior doctor that I was and wish I'd understood the bigger picture to feel less helpless. Had these opportunities been more available five years ago, would I still have left? Or was I so disillusioned that I wouldn't even have recognised them as opportunities?
There have been other advantages to leaving though. I have a career which I control, and am no longer drifting in the uncertain quagmire of medical training. Things that make my work more productive are sorted out – like having a desk, an IT service, a career advisor, health insurance, and office bonding trips to warm places. People ask me how I'm feeling the whole time, which at first felt very intrusive, but now feels like a license to ask for more office bonding trips. I get sent on training to learn about financial accounting in Paris and business school essentials in Barcelona. And not once have I been told to 'feel free to cope' in the middle of the night, holding the bleep as patients go off all around me.
Of course there are downsides. Practicing medicine is a privilege: we are allowed to see so deeply into aspects of other peoples' lives. I miss the human interactions that come with taking care of patients, and if I'm honest I also miss the instant gratification that comes with making them better. I miss the shared sense of cynicism about life that is so particular to medics – my current colleagues still have their innocence utterly intact, unbroken by that first massive haematemesis or first messy arrest.
Finally, part of me still can't believe I really did this. I jumped off the proverbial cliff and resigned from a hard won MMC number at my own medical school to be a management consultant. I also (as people frequently tell me) squandered a quarter of a million pounds worth of taxpayers' money spent on my training. And so I for a long time I felt deeply guilty about my newfound professional happiness. But overall, I am sad to reflect that leaving medicine has been one of the most rewarding and fulfilling things I have ever done, even if nobody does have a clue what I do for a living.
One of the reasons that people find the whole concept baffling is that the consulting industry varies hugely from firm to firm and project to project. Consultancies come in all shapes and sizes – specialist, generalist, small, large, local, global – and each project a firm does will be different to the last one – in a different industry, for a different company, with a different team, for a different reason. Even within healthcare, projects can range from redesigning manufacturing at a large pharmaceutical company to improving patient safety at an NHS trust. However, in its most basic form, consulting has many parallels to medicine. Companies have many ailments (currently they mostly have costs) and consultancies find ways of making them better. At its worst it involves spending a lot of money for no discernible improvement, but often it can help overcome difficult problems with the benefit of an external perspective and additional manpower.
On a personal level, becoming a management consultant has offered me a whole new perspective on the world - many doctors are fairly business minded but I really wasn't, and so for me it has been transforming. I read The Economist, recognise supermarket pricing strategies targeted at me, and have coherent conversations about my mortgage interest rates. Importantly, I also see healthcare differently. I understand the debate about finite funding and expanding demand, about how outcomes tend to be better with centralisation but nobody wants to close their local hospital, about tariffs, PCTs, SHAs, CCGs and all manner of three letter acronyms so beloved of the NHS. I also recognise the importance of having medics who understand management in the system (and indeed, managers who understand medics), instead of viewing them with deep scepticism. Many are finding flexible ways of balancing their management, leadership and clinical aspirations - they attend Diagnosis Salons, participate in SHA leadership schemes, and follow role models like Claire and Emma down an alternative path. I think back to the angry junior doctor that I was and wish I'd understood the bigger picture to feel less helpless. Had these opportunities been more available five years ago, would I still have left? Or was I so disillusioned that I wouldn't even have recognised them as opportunities?
There have been other advantages to leaving though. I have a career which I control, and am no longer drifting in the uncertain quagmire of medical training. Things that make my work more productive are sorted out – like having a desk, an IT service, a career advisor, health insurance, and office bonding trips to warm places. People ask me how I'm feeling the whole time, which at first felt very intrusive, but now feels like a license to ask for more office bonding trips. I get sent on training to learn about financial accounting in Paris and business school essentials in Barcelona. And not once have I been told to 'feel free to cope' in the middle of the night, holding the bleep as patients go off all around me.
Of course there are downsides. Practicing medicine is a privilege: we are allowed to see so deeply into aspects of other peoples' lives. I miss the human interactions that come with taking care of patients, and if I'm honest I also miss the instant gratification that comes with making them better. I miss the shared sense of cynicism about life that is so particular to medics – my current colleagues still have their innocence utterly intact, unbroken by that first massive haematemesis or first messy arrest.
Finally, part of me still can't believe I really did this. I jumped off the proverbial cliff and resigned from a hard won MMC number at my own medical school to be a management consultant. I also (as people frequently tell me) squandered a quarter of a million pounds worth of taxpayers' money spent on my training. And so I for a long time I felt deeply guilty about my newfound professional happiness. But overall, I am sad to reflect that leaving medicine has been one of the most rewarding and fulfilling things I have ever done, even if nobody does have a clue what I do for a living.
Tuesday, April 3, 2012
My placement at Candesic Healthcare - By Amardeep Bains
My autumn one-month placement at Candesic Healthcare Consultancy couldn’t, in my opinion, have provided a better experience. I think, especially in my case being a dentist, one normally envisages a life spent drilling and filling after the DF1 and DF2 years. However, after completing my SHO year in Oral and Maxillofacial Surgery I was determined to look outside the box. What better way to broaden your outlook on healthcare provision than to pursue a work placement with a leading healthcare consultancy firm? Well, that was my rational prior to taking up the position, and I can safely say that in hindsight whilst writing this review I definitely have no regrets!
Under the watchful eye of Dr Chua the transition from screaming babies and ungrateful patients in A&E to the pristine, air-conditioned offices on the upper floors of New Zealand House was definitely smoother than expected. From the onset I was made to feel part of the team and no time was wasted orchestrating the first meeting and conference call. I would say I very much hit the deck running in that respect which didn’t really allow me to reflect on working in a new environment- definitely a positive.
Given that the particular project I was based on was dental related meant that I could provide useful insight into the workings of the dental industry. In return, I was able to see how such information was collected, analysed and brought together in manner typical of a healthcare consultancy firm. From interviewing dentists across the UK in person and on the phone as well as contributing key slides towards the final presentation meant that I was an integral part of the team. The workings of a healthcare consultancy team are very different from what I had been previously used to. Of course, much more time is spent in front of a laptop and there were some challenges and disagreements amongst members of the highly self motivated and determined team regarding the conduct and progress of the project. However, I must add at this point that although at the time this did provide an element of frustration, it only served to enhance my team working, communication, leadership and life skills in the long run for which I am grateful.
I would like to finish by sharing the highlight of my experience: interviewing the Chief Dental Officer of the United Kingdom at his DoH office. I would like to thank Dr.Chua for giving me such a fantastic opportunity as well as providing me with such an invaluable insight into the workings of a reputable healthcare consultancy firm over the one month period. I have no hesitation in recommending Candesic-Thank you.
Blog By Amardeep Bains
http://www.candesic.com/index.php
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