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.

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!)


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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!...

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.

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.

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.

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.

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