{"id":40563,"date":"2017-11-09T12:39:28","date_gmt":"2017-11-09T11:39:28","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=40563"},"modified":"2017-11-17T17:54:40","modified_gmt":"2017-11-17T16:54:40","slug":"shiv-chande-we-need-to-bridge-the-gap-between-clinicians-and-managers-to-improve-junior-doctors-morale","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2017\/11\/09\/shiv-chande-we-need-to-bridge-the-gap-between-clinicians-and-managers-to-improve-junior-doctors-morale\/","title":{"rendered":"Shiv Chande: We need to bridge the gap between clinicians and managers to improve junior doctors’ morale"},"content":{"rendered":"

\"\"In autumn 2016, I stepped out of my clinical training to become a leadership and management fellow at Health Education England (HEE), with the aim of gaining a different view on healthcare. In already-crowded curricula, there is limited time to expose junior doctors to leadership and management, despite its notable presence in the job descriptions of senior clinicians. In many junior doctors\u2019 eyes, positions in leadership and management are perceived as part of the “dark” side of the NHS with more money and less compassion.<\/p>\n

During the junior doctors\u2019 contract dispute, these feelings became apparent and were further exacerbated by the media stirring a heated cauldron of emotions. While the importance of scrutinising those in positions of responsibility and holding them to account is irrefutable, perceptions of leaders and managers as less moral or solely incentivised by financial gains are typically inaccurate and damaging. This year my experience of working with this group of colleagues has not supported this narrative. Part of my appreciation for them has grown from understanding the necessity for those in NHS-affiliated organisations to work in alignment with government policies and manage expectations of the Department of Health.<\/span><\/p>\n

These insights highlighted to me the importance of bridging the gap between clinicians and managers, rather than allowing divisive stereotypes to perpetuate and deter our collective efforts to improve overall productivity and patient care. Reassuringly, this year I have found that senior leaders do care about junior doctors\u2019 morale, as demonstrated by their enthusiasm and commitment to support work on the issue<\/span>. [1] Indeed, they acknowledge the inadequacy of the system to enact the NHS Constitution\u2019s 3<\/span>rd<\/span> central principle:<\/span><\/p>\n

“Respect, dignity, compassion and care should be at the core of how patients and staff are treated — not only because that is the right thing to do, but because patient safety, experience and outcomes are all improved when staff are valued, empowered and supported.”<\/span><\/p>\n

This year, <\/span>HEE listening exercise<\/span><\/a>, triangulated with existing data on junior doctors\u2019 morale, yielded three key themes for why morale is low. [1] They all relate to the 3rd central principle:<\/span><\/p>\n

    \n
  1. Not feeling supported<\/span><\/li>\n
  2. Not feeling valued and<\/span><\/li>\n
  3. Not having autonomy<\/span><\/li>\n<\/ol>\n

    When faced with burnout and working in resource-constrained environments, it\u2019s difficult to know where to begin to fix these problems. Importantly many junior doctors do have experiences of good training and working environments with correspondingly higher morale, features of which were outlined in the <\/span>listening exercise<\/span><\/a>. [1] This led our team of fellows to initiate a project with NHS Improvement to gather examples of good practice and understand how they were achieved, what constraints were overcome and what resources were required. Success often included a pro-active executive team, providing space for managers and junior doctors to listen to each other and find solutions together. These case studies have been uploaded to the <\/span>NHS Improvement Hub<\/span><\/a>, and are being distributed widely to expedite improvements to morale. [2] The examples collected include interventions such as: <\/span><\/p>\n