Consultant Intensivist Transitioning Course

There is a general acknowledgement that medical training programmes focus on the clinical aspects of the job. Insight is important in any illness and there is now a recognition that the non-technical and non-clinical aspects of being a consultant in Intensive Care Medicine are often neglected. We are literally exxpected to lead a multidisciplinary team, interact and negotiate with colleagues from across the hospital and from various specialties in often stressful and challenging situation. Businesses especially the multinationals, invest heavily in developing their team and leaders. The NHS through the organisation such as the Faculty of Medical Leadership and Management are also starting to do the same for healthcare professionals.

In Australia and New Zealand, the Consultant Intensivist Transitioning (CIT) course is a compulsory course for all their registrars. This is the inaugural UK CIT course with national and international experts forming the knowledgeable and passionate faculty. Whilst there are other medical management courses in the UK, this is specifically designed for the Intensive Care Consultant.

The ProgrammeScreen Shot 2016-05-11 at 18.56.07

Aspects and areas covered;

  • Leadership
  • Legal aspects
  • Conflict management
  • Negotiation
  • Managing performances
  • Managing and initiating change

The sessions are interactive with almost no didactic lectures.

Segun provides a more personal account (below) but my take-home message would be:

  1. Decisions are made before the meeting; do your homework and prepare.
  2. Reinforce what you do well to make yourself indispensable.
  3. Legal issues can be very daunting – are your processes robust enough for patient safety?
  4. Work-life balance is a choice.
  5. By knowing yourself, you are better able to manage yourself and understand others.

In conclusion, this course is merely the starting and provides the foundation for a lifetime of learning and development. By better understanding ourselves and what motivates us, we can form better relationship with those around us; colleagues and most importantly, patients. As mentioned above, there are other medical management courses available, but to my knowledge, this is the only on which is specific for ICM.

Dr James Day and Dr Graham Barker should be congratulated for organising this course in the UK and I whole heartedly recommend it. Thanks to @RoodenburgO @cmoMD @DannytheBaker and the rest of the faculty.

Adrian Wong, Consultant ICM/Anaesthetic (ESTJ)

 

Reflections from the CIT

St Anne’s college, Oxford. A rainy Tuesday morning.

I’m sitting with a number of intensive care colleagues, intently concentrating on Dr Owen Roodenburg, Consultant Intensivist. He’s travelled all the way from the Alfred Hospital in Melbourne to speak to us.

His hospital specialises in ECMO, Echo, VADs, and recently ran the CHEER trial looking at Intensivist delivered ECMO for in-hospital arrests.

Yet today, he is talking to us about none of those things. He is talking about…change.

Today is the UK’s first Consultant Intensivist Transition (CIT course). 19 delegates are being taken through a series of exercises, introducing them to the “hidden curriculum” of being a consultant.

It’s a varied and exciting bag. Following this introduction to the mechanics and psychology of change, Jonathan Fielden- an intensivist with a long career in health politics and now working in the department of health- talks to us about his approach to meetings. (Having been BMA Consultant head for many years, he’s been to a few).

We take part in a mock meeting. Role playing different team

Members, each with differing agendas, it’s remarkably realistic- and brings up many discussions about how each of us copes in these environments.

It’s easy to think that we’re going to show up as the new sheriff in town, and change everything. In another session on “initiating change” we are reminded how it’s not always the case. Another mock exercise pitching a new service follows.

We break for lunch and network. Dr Helen Higham from OxSTAR takes us through a fascinating session on managing under stress. Situation awareness and cognitive biases continue to dog us as consultants. Simulation training can help this, thankfully- as can being good to your nursing team. Matt Holdaway from Oxford Adult ICU gave plenty of pointers on keeping nurses happy (don’t touch the ventilator without telling them! And it’s THEIR ventilator!)

Day one ended with a lovely session on work-life balance from Jonathan Goodall, and a session on law talking us through complaints, coroners and all in between.

DAY 2:

“And this above all, to thine own self be true”

We start by learning about our Myers Briggs personality types, and how different traits interact. This leads nicely into sessions on conflict management (not easy!) leadership (not as straightforward as you’d think!) and negotiation (which is not “getting your own way”).

I had to leave after this session, but left fired up and full of idea.

There’s been nothing like this formally taught in ICM training in the UK before. The faculty were engaging, knowledgeable, and genuine.

Most importantly they reminded us of the highest truth.

Intensive care is about people. Patients are people. Staff are people. All of our interactions involve people. And we, the consultants of the present and future, are people.

We need to care about people. Start with ourselves. Do things we love, in and out of work. Rest. Exercise. Eat well. Manage ourselves in stressful situations.

We need to care about our team mates. Listen to them. Be empathic. Train our emotional intelligence. Negotiate with them to achieve the best outcomes for all

Involved, not just to get our own way.

When we do that, the people that we have been trained to care about- the patients- get the best from us, and from everyone else.

Segun Olusanya

ICM

Critical Care Reviews meeting 2016 blog – Session 1

Critical care reviews is a one day meeting in Belfast by Rob Mac Sweeney and the Northern Ireland Intensive Care Society.  Adrian Wong and Jamie Strachan attended and have put together these notes for oxicm. Rob is going to put all the talks online over the next few weeks.

The Great Debate: RCTs are Killing Critical Care

Jean-Louis Vincent (@jlvincen): Damn Right!

We should abandon randomized controlled trials in the intensive care unit.

-Fluid, BP, Hb, feeding all have been RCTed to show no benefit.

-Chest compression has never been RCTed and yet we still use and continue to investigate around its “fringes” e.g. LUCAS, continuous vs interrupted.

-Its the process of care NOT the actual RCTs that have advanced ICM.

-In conclusion, JLV advocates personalized and precision treatment plans

Luciano Gattinoni (@gattinon): You’re Having a Laugh?

The logic of RCTs and scientific reasoning

1

– It is not the RCTs but the interpretation and implementation of their findings that is the problem.

– Are we (all) too quick to throw away treatments after RCT? ECMO was discarded for 30 years after 1970 says @gattinon

– Problems with RCTs – premise and external validity. Not asking the right question – Wrong study=wrong result

2.png

Discussion

JLV and Gattinoni both say – we are asking the WRONG questions.

Interesting articles

Paul Young (@DogICUma): Saline or Plasmalyte? Is SPLiT the Solution?

Great discussion on this trial – well covered online in other places:

Original paper | Editorial to manuscript |@WICSBottomLine Review | @stemlyns Review

6.png

New data from Young was presented at this meeting however:

 

But this a non-significant result and was from a post hoc analysis of a non predefined subgroup, as Simon Carley pointed out from the twittersphere:

What it did do is help Dr Young and his colleagues with their next project- the PLUS trial: PlasmaLyte versus Saline trial – 40 sites, 8800 pos ? the definitive trial comparing plasmalyte and saline.

John Holcomb: How to Resuscitate PROPPRly

Transfusion of Plasma, Platelets, and Red Blood Cells in a 1:1:1 vs a 1:1:2 Ratio and Mortality in Patients With Severe Trauma The PROPPR Randomized Clinical Trial

Again well covered elsewhere but a great run through today from John:

@WICSBottomLine Review | @stemlyns Review | @theSGEM Review

Other points:

– plasma is a drug with thousands of proteins in it

– Holcomb explains survival bias: Did they live because they got the whole blood or did they live long enough to get the whole blood?

– PROMMTT data: “transfusion was random across centres”

– KM Curves in PROPPR already started separating within 3 hours

– Median time to haemorrhagic death in trauma 2.5hrs. It is products we give before this time that hold importance

– No point of care coagulation test is fast enough to keep up in active bleeding.

Tim Walsh (@Ed_TimWalsh): Is Old the new Young? The ABLE Trial

Age of Transfused Blood in Critically Ill Adults | @WICSBottomLine Review

7

The conclusion?  – Fresh red cells do not appear to be superior to standard issue red cells in critically ill adult patients.

Tim Walsh made the great point that so-called negative randomised control trials can reassure us we are doing no harm.

 

Critical Care Reviews meeting 2016 blog – Session 2

Critical care reviews is a one day meeting in Belfast by Rob Mac Sweeney and the Northern Ireland Intensive Care Society.  Adrian Wong and Jamie Strachan attended and have put together these notes for oxicm. Rob is going to put all the talks online over the next few weeks.

Session 2 was “How i manage…”

Luciano Gattinoni (@gattinon): Hypoxaemic Respiratory Failure

Know the baseline sats and RR (without O2) – response to oxygen tells you about the shunt

Knowing the PaCO2 tells you how much tired the patient is

If sats don’t improve with O2, shunt fraction is close to 30%

Gattinoni would intubate moderate/severe ARDS immediately

Know the diagnosis and the treatment! Don’t just manage ARDS

Test the oxygenation at PEEP 5

When increasing PEEP, measure central venous oxygenation and check scvO2. If scvo2 & paO2 both go up good. If 1 goes down serious harm instability

Friday night ventilation: a safety starting tool kit for mechanically ventilated patients

Jean-Louis Vincent (@jlvincen): Septic Shock

Give antibiotics – early and the correct ones

8.png(@Doctor_J_)

Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection

Source control needs to be rapid.

9.png(@david_menzies)

Microorganism is ultimately discovered in 77% of @jlvincen septic patients

So de-escalate antibiotics – quickly if you can

10.pngVIP – ventilate, infuse and pump

Individualise the fluid strategy

The phases of fluid strategy – SOSD – salvage, optimize, stabilization, de-escalation

Four phases of intravenous fluid therapy: a conceptual model

Don’t touch pt during fluid challenge!

Passive leg raise – but it’s too complicated. Just give fluid challenge and watch cardiac output

JLV – start noradrenaline early and he would start dobutamine

Concept of SEPSIS Team

Paul Young (@DogICUma): Pyrexia in ICU

Acetaminophen for Fever in Critically Ill Patients with Suspected Infection

@WICSBottomLine Review

Paul had 6 take home messages:

  1. “Converting peripheral temp to core by adding 0.5 is a bit dodgy”
  2. “The temperature that is not on the chart is not as accurate as you think”
  3. “If temperature >39 intermittently, consider continuous monitoring”
  4. “If temperature control is important, I typically administer paracetamol regularly”
  5. In morbidly obese, external cooling may worsen things initially because of vasoconstriction
  6. 48hrs of ibuprofen appears to be safe and well tolerated in sick ICU pts

Young: Keep the pts alive for long enough so that they will get better themselves

John Holcomb: Traumatic Haemorrhage

Think about 2am medicine when planning strategies/guidelines

Most trauma deaths occur within 1 hr

Moving thawed plasma from lab to ED, reduced time of administration by 40 minutes

No blood test is fast enough to manage the initial phase – No point in lab tests whilst pt actively bleeding. Goal directed transfusion starts when bleeding stops

“Giving blood does not stop bleeding”

How I treat patients with massive hemorrhage

Tim Walsh (@Ed_TimWalsh): Anaemia in ICU

Anaemia is common

Causes of anaemia on ICU

  • Haemodilution
  • Blood letting
  • Blood loss
  • Marrow suppression
  • Iron met supprssn
  • Chronic disease
  • Reduced RBC life

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10 good practice points:

  1. Transfuse blood when it obviously saves lives
  2. What does Hb mean – concentrated etc
  3. Avoid excessive blood letting
  4. Don’t routinely administer iron – IRONMAN trial awaited
  5. Don’t administer erythropoietin
  6. Use single unit RBC transfusion in non-bleeding pts
  7. Early sepsis might be different BUT only when there is a clear evidence of tissue hypoxaemia
  8. Make individual judgements for the pt with cardiovascular disease
  9. Don’t ask for fresh blood
  10. Don’t transfuse unless Hb<7 in young, healthy pt

Restrictive versus liberal transfusion strategy for red blood cell transfusion: systematic review of randomised trials with meta-analysis and trial sequential analysis

Critical Care Reviews meeting 2016 blog – Session 3

Paul Young (@DogICUma): Should we treat the HEAT?

WICS Bottom Line review

What is the point of fever?

Helps fight infection in animals…

  • Mice and klebsiella
  • Pigeons and pneumococcus
  • Bees and fungal infections

The higher the temperature in first 24 hours in those with an infection, the lower the mortality

In pre-defined analysis of survivors and non-survivors, paracetamol seem to prolong life of these non-survivors

Reasons that this might be:

Paracetamol blocks oxidative stress. Maybe it’s useful in delaying death and facilitate a window for recovery in ICU?


Anthony Gordon (@agordonICU): Vasopressin or Noradrenaline: should either VANISH?

VANISH isn’t published yet (its not quite through the peer review process!) but it has been presented at meetings so is fair game for a quick summary…

Untitled2UntitledThe role of vasopressin differs in health and shock/septic shock.

VASST trial

VANISH trial design

Vasopressin did point towards an increase in digital ischaema vs norad (although Confidence interval crosses zero)

As promised Anthony Gordon would:

  • 1st line Noradrenaline
  • add vasopressin earlier but no magic number
    • Especially if renal dysfunction developing or arrhythmias/tachycardias
  • Care with vasopressor combination especially in combination
  • Steroids

Pending Rob releasing this talk or the paper coming out, try this from December:

Tim Walsh (@Ed_TimWalsh): Does Rehab help ICU patients RECOVER?

Exploring the scope of post-intensive care syndrome therapy and care: engagement of non-critical care providers and survivors in a second stakeholders meeting

Increased Hospital-Based Physical Rehabilitation and Information Provision After Intensive Care Unit Discharge The RECOVER Randomized Clinical Trial

Pts refused trial as they were “too tired”.

NO benefit shown except for some pt satisfaction scores – but is this a reflection of their premorbid state? So RECOVER hasn’t shown a benefit despite all the investment and application of “seems like a good idea”

Cost of intervention is £700 per patient treated

Exercise rehabilitation following intensive care unit discharge for recovery from critical illness

Christopher Nutt (@nuttchristopher) 2015 Critical Care Literature: The Best of the Rest

*Chris stepped up when Rob “The Machine” MacSweeney broke down.

Amongst the numerous studies discussed……. YOU HAVE TO LISTEN TO THE RECORDING. All the important 2015 trials summarised in 25 minutes! And try and beg/borrow/steal the outstanding conference book.

EUROTHERM – worse neuro outcome and mortality in intervention group

EPO-TBI

ICEREA – Endovascular versus External Targeted Temperature Management for Out-of-Hospital Cardiac Arrest Patients: A Randomized Controlled Study

Effect of Corticosteroids on Treatment Failure Among Hospitalized Patients With Severe Community-Acquired Pneumonia and High Inflammatory Response

FLORALI

Driving Pressure and Survival in the Acute Respiratory Distress Syndrome

PERMIT Trial

TiTRE2 Trial
3 SITES Study

 

Critical Care Reviews meeting 2016 blog – Session 4

Session IV

Panel Discussion 2015 Critical Care Literature – What I Thought of It

(This blog does no justice to the quality of discussion that occurred. Watch out for the recordings.)

EuroTHERM – the fallout when a trial is stopped early.

NO data on paracetamol as one of the most commonest drug used in the world

Holcomb: Let’s make sure we understand the basic of what we do everyday before we start looking at new things.

Less is more – least, most, minimum

Paul Young – Lancet paper on hypophosphotaemia and feeding strategy (DogICUma’s best of the rest paper of the year). Needs an answer re: nutrition – TARGET trial

Antony Gordon – stem cell therapy

Holcomb – prehospital blood products. Closed-loop technology to aid clinical decision making

Walsh – transfusion targets in high risk CVS pt. Blood products for invasive procedures such as line insertion on ICU

John Hinds’ Trauma Lecture: Brian Burns (@HawkmoonHEMS) Trauma Care – Back to the Future

Adrian’s personal note: I have known about John’s work through the wonders of social media for a while before finally meeting him in person at SMACC2015. 2 things struck me when we first met – 1) cool, he has kept the ponytail and 2) he isn’t very tall. But after talking to him, his passion, enthusiasm and humility was my overwhelming impression of him. If you’ve never heard him speak, have a listen to these two talks – they are brilliant.

Crack the chest: Get cruxified

Cricolol

A great tribute to start with John’s helmet on stage.

The range of topics presented

  • Blood products
  • Tranfers/MTC
  • REBOA
  • Impact Brain Apnoea – role of brainstem, role of catecholamine surge
  • Traumatic cardiac arrest – Algorithm from HEMS

Adrian Wong’s guide to applying for a consultant job

Consultant application – my story and tips

a blog for OXICM by Adrian Wong, newly appointed consultant intensivist in Oxford

Nothing quite signifies the end of your training than the fanfare of the consultant application process. During my registrar years, there was always an exam to look forward to, hospitals from which to move. The consultant application crept up on me; I delayed the inevitable by applying for a post CCT fellowship. Finally, after a year of searching and 2 failed consultant interviews, on the 27th of August 2015 at approximately 1345, I was third time lucky and secured a substantive post (subject to contract being delivered by HR). Here are some tips I gathered along the way.

A bit of background. I had dual trained in Intensive Care Medicine and Anaesthesia and was awarded my CCT on the 14th of December 2014.

The Pearls

The Search

If there is a department and a job you want, be proactive and let them know. The worst they can say is No. Keep in touch and asked to be kept informed.

Visit departments you would consider working in, most of them would be happy to talk to you and show you around.

Both NHS jobs and BMJ Careers have email alert settings once you have registered. Having said that, be methodical with your search criteria – jobs aren’t always listed under the obvious headings. E.g. anaesthesia, anaesthetist, anaesthetics have to be included.

Healthjobsuk.com is another website worth keeping your eye on.

Application

Know your CV! Identify your Unique Selling Points (USPs) and areas of interest. Three is a reasonable number; if you have more, pick your strongest three. If you think you have none, ask your colleagues.

Show your CV to senior colleagues – when I did this, all of them picked out the same three USPs to highlight as my strengths. I recommend doing this early as it will help you focus and plan a consultant-level CV.

Only apply for jobs that you want. Sounds silly but imagine yourself being offered the job. What would your reaction be? Woohoo or oh bugger? It is still alright to withdraw your application if you find that it does not suit you after visiting the place, but to reject a job offer or to leave the post shortly after will often be looked upon as highly unprofessional.

Personally, I place great emphasis on future potential – it is not what the unit/department is now but what it could be that matters to me. Equally, I’d like to think that trusts are looking for someone they can develop to maximise his/her potential. The consultant post is, after all, just another chapter in a lifetime of learning and improving.

Read the job description and tailor your CV/application form accordingly. Pay close attention to the person specifications. Address all the essential criteria and then highlight your desirable ones (Reassure and dazzle).

Visits

IMHO, the minimum list of people you should visit include:

  • Clinical director and/or lead
  • Medical director
  • Divisional manager and/or lead
  • Anyone involved in your area of interest or USP
  • Members of the interview panel (if already known)

Find out about the department/trust strengths, weakness, challenges and priorities. My visits gave me a good idea about the trust’s vision, plan, priorities and direction of travel. Ask how this post fits into the bigger picture. PLAN YOUR VISITS – you wouldn’t just turn up for a date without prior preparation e.g. travel anecdotes, an interesting book, favourite food truck etc.

These visits are also meant to help you decide if you wanted to work there. As an example, despite the excellent geographical location of a hospital I was interested in, there were several issues that would have been near impossible to overcome over the duration of my working life.

At the end of the visits (especially to the interview panel), you would hopefully have a clear picture of the priorities of each individual and the trust. Therefore, at the interview, you will be able to address them (reassure and dazzle).

Management issues

Know the trust’s management structure.

Download their reports, annual review, newsletters, guidelines, protocols, policies – you MUST visit the trust website. Twitter, Facebook, LinkedIn profiles should be part of your background research. It highlights the way the trust engages not only with the public but also their own staff.

Most trust have a mission statement or core values. Know them and incorporate into your answers.

NHS issues – this is where I found the ISC course book very useful.

Definitions of clinical governance, audit, safety etc. – it is meaningless to memorise the textbook answer. Instead, consider what it means to you and back it up with examples.

Interview preparation

Know you strength, weakness and USPs.

Know your competition’s strength, weakness and USPs (wherever possible).

Identify your three most important selling points. You MUST, MUST, MUST get them across.

Prepare answers to the predictable questions. Reassure the panel and then dazzle them.

Practice, practice, practice – find a colleague, loved one, willing pet. Rehearse the important opening gambit/pick up line. If there is a presentation to prepare beforehand, be mindful of the time limit, check that the format is appropriate for the equipment provided and ensure that the slide auto-transition mode is switched off (this is sadly from personal experience).

Useful websites

www.bmjcareers.com

www.isc-medical.com

www.kingsfund.org.uk

www.nuffieldtrust.org.uk

www.gmc-uk.org

Trust website

Your own specialty website

Conclusion – Goodbye Wessex, Hello Oxford

Applying for jobs and preparing for interviews take far more time than you might imagine, and this has been one of the most stressful periods in my career, so much so that I would rather sit the FFICM again. It often means that you have to put certain projects on hold, and find time to arrange meetings with extremely busy people. If you manage to get a job after one interview, you have done very well indeed. If not, take a short break, learn from the feedback of the panel, and start afresh. Do not lose heart, it is just a matter of finding the hospital perfect for you, that also thinks you are perfect for them, so keep trucking.

It was a huge relief to realise that I was appointable and to be able to work alongside friends and valued colleagues. I would not have been able to get through this without the support of my wife, friends and mentors. There are too many to thank but a few I would like to mention –

  • Graham Barker
  • Steve Mathieu
  • Gordon Craig
  • Jonathan Chantler (he who coined the mantra ‘reassure and dazzle’)
  • Jonathan Harrison
  • @traumagasdoc

As I have been told, the interview is only the first step… the real work starts after that! Wishing you all the very best with your preparations. If you have any comments/feedback or any advice to add, please feel free to drop me a line.

ICS Blog

A blog by Adrian Wong, CUSIC fellow in Oxford.

One of my highlights from the ICS State of the Art meeting 2014 was the talk by Prof Brindley on the final day of the conference. Entitled ‘Resuscitation – not as easy as A, B, C’, I was expecting an update of sorts on resuscitation of critically ill patients. Instead, what followed was an engaging and captivating talk about teamwork, communication and human factors within the intensive care unit. One quote in particular, resonated very strongly with me – “A team of experts isn’t an expert team”. Teamwork is more than just subordinates doing what the leader says. It is about maximising the mental and physical problem-solving capabilities, such that the sum exceeds its parts.

Personally, one of the main challenges of working in critical care is the fact that we are truly a multi-disciplinary team. From doctors to nurses, to allied health professionals such as dieticians and physiotherapists, we all play our part in trying to deliver the best possible care for our patients.

A genuine no-blame environment where organisations learn from their mistakes is often iterated in medical management and is something we should aspire to. The events of MidStaffs and its subsequent reports have made all healthcare professionals take a long hard look at themselves. People were too afraid to come forward, to raise concerns about the care patients were getting or rather not getting. The new statutory duty of candour was introduced for NHS bodies in England (trusts, foundation trusts and special health authorities) from 27 November 2014, and will apply to all other care providers registered with CQC from 1 April 2015.

Duty of Candour – The volunteering of all relevant information to persons who have or may have been harmed by the provision of services, whether or not the information has been requested and whether or not a complaint or a report about that provision has been made. (Francis)

Every healthcare professional must be open and honest with patients when something goes wrong with their treatment or care which causes, or has the potential to cause, harm or distress. Organisations should continuously be vigilant against potential systems failure.

Intensive Care Medicine is a dangerous specialty

Working in such a high pressure, time-critical environment with high functioning individuals, it is easy to see how mistakes can happen. Medicine has begun to embrace the concept of human factors when dealing with medical errors. Human factors encompass all those factors that can influence people and their behaviour. In a work context, human factors are the environmental, organisational and job factors, and individual characteristics which influence behaviour at work.

It is very seldom that medical errors occur due to a single mistake. They usually occur due to a systems failure – the oft-quoted Swiss cheese model. Hence it is important that errors are analysed and lessons learnt to prevent recurrence.

The landmark case of Elaine Bromiley, who died following surgery, has highlighted the importance of human factors in ensuring optimal performance of the team. I believe that it has made the medical profession look at itself and accept it is human. Elaine was cared for by a team of experts comprising no fewer than 2 consultant anaesthetists. Doctors and especially consultants are expected/assumed to be good leaders to the rest of the medical team. Yet, as Professor Michael Harmer stated in his independent review:  “This was a tragic case from which many lessons can and need to be learnt.”

Becoming an expert team

Teamwork in the intensive care unit refers to the leadership, decision-making, communication and coordination behaviours used by multidisciplinary team members to provide patient care. Patient safety research has demonstrated the importance of effective teamwork in ensuring positive patient outcomes in the ICU. Borrowing from the aviation industry’s Crew Resource Management, medical teams now use a combination of simulation as well as classroom-based teaching.

Healthcare teams are usually trained in technical aspects of their job but typically receive no human factors training. Hence, the lack of attention to training in non-technical skills and raising awareness of common error traps explains why the research literature and major incident reports are replete with examples of leadership, situational awareness, communication, coordination and teamwork failures. Indeed a common feature for such human factor courses, is that the focus should not be on the individual technical skills but rather how the team functions. The feedback and debriefing process are key elements to such training.

Underpinning all of this is engagement between the individual team members. Engagement is crucial and yet members of the team will not do so unless they feel “safe” to do so. A key effect in the introduction of the WHO Checklist is emphasis on the team. Every member of the team introduces him/herself. Such a simple action empowers individuals to be brave and speak up when they have concerns, thereby levelling the traditional hierarchical arrangement of medicine. The patient’s wellbeing is the overwhelming priority. As mentioned above, the Duty of Candour means that every healthcare professional has a responsibility to raise concerns about a failing team.

iinteamThere is no I in Team.

What do you do about a failing/flailing team? What do you do about the individual who is compromising team performance? The team is only as strong as its weakest link. There are national documents when it comes to dealing with failing doctor including consultants.

The bottom line is this, ask yourself, are you prepared to stand up for the team and hence the patient? How will you deal with the non-team player who refuses to be trained? Prof Brindley has the answer – sack them.

References

www.midstaffspublicinquiry.com ¦ Duty of Candour ¦ Patient safety first – implementing human factors in Healthcare

Adrian wrote this blog for the Intensive Care Society in his role as the chair of the Trainee Committee.