Editorial

Citation

Gourlay, R. (2001), "Editorial", International Journal of Health Care Quality Assurance, Vol. 14 No. 7. https://doi.org/10.1108/ijhcqa.2001.06214gaa.001

Editorial

One of the pleasures of my work is directing seminars on management topics for doctors in training. For many of them the concepts and practices of management are quite unfamiliar; many indeed know little of the organisational structure within which they are working. But however lacking in knowledge they are about these things, they are certainly intelligent with an analytic approach that throws up many challenges to conventional management wisdom. They think about their work and its context and what could be done to improve their lot and that of their patients. They have ideas and enthusiasm, and often some energy as well. All this is very exciting for a course director but it is also very frustrating.

Why?

Because many of their ideas and thoughts are stillborn. There appears to them to be no channel through which they can express their suggestions and thoughts on improvement. And even when the chief executive invites them to meet him/her, the logistics of setting this up beats the young doctor. It is well-known that those who do the job often have many thoughts on what could be done better. In the past we have had "action learning sets"; "quality circles"; "participative management" and so on, all with the aim of tapping into the potential of those who "do".

For the doctor in training, it is difficult if not impossible to find the time to get involved with these management initiatives. Their focus is the care of the patients and their examinations – many of them work excessive hours already, and have little time to spare for "management type meetings".

In my sessions on quality during the seminar, we discuss the costs of poor quality and what actually happens that increases costs. Examples include the delays in operating on patients with fractured neck of the femur, where such delays can lead to complications; another example discussed is poor patient discharge arrangements, because no one is overseeing these. A very serious example was given where equipment used for injecting in the vein is also compatible with injecting into the spine, leading to actual mistreatment of the patient and his subsequent death.

Many administrative processes also cause the problem which some thought could be easily overcome. An example here would be handwritten pathology requests by GPs, which are illegible and need phone calls to sort out.

There is no doubt that any reader could multiply these examples many times and, if discussing them with doctors in training, would get a load more.

But nothing happens – not because of laziness or some other malfeasance, but because there appears to the doctor in training to be no one who cares; and, if there is, trying to get to see them is a nightmare. And, if they do get to see them, they feel that they may not be taken seriously, or pushed aside, "because there are no extra resources".

In essence what happens is that the doctor in training gives up. As he or she is probably on a training rotation, they have only a little commitment to the hospital and any slight setbacks will be enough to reduce what commitment was there in the first place.

What is the solution? If organisations really do believe that "staff are our greatest asset", then some investment in the potential of the asset should be made.

As a starter we suggest that, just as there are "patient advocates", there should be "staff advocates". A post could be created with the following remit:

1. 1.

   Title: innovation manager.

2. 2.

   Reports to: chief executive.

3. 3.

   Remit:

4. 4.
   • •

     To be available to all members of staff within two working days of a request.

   • •

     To collect and evaluate the potential of all ideas aimed at improving patient care and/or saving costs.

   • •

     To provide support and feedback to the idea proposed and to facilitate experiments/pilots etc. to test new ideas.

   • •

     To recommend recognition for idea proposers.

Targets could be set for the postholder in terms of:

• •

  contacts made with various individuals;

• •

  number of ideas tested;

• •

  number of ideas introduced;

• •

  quality improvements in the patients' experience;

• •

  savings made in time and costs.

The qualities required of an innovation manager include that of robustness. Introducing new ideas or ways of working will arouse the conservatism in many. The innovation manager will have to deal with a whole list of reasons why a change could not be made. He/she needs to be able to win people's commitment to introducing new processes, even though they may initially be antagonistic.

The power they would have is really derived from their own characteristics, although, as direct reports to the chief executive, they can trade on this source of power!

It is important that the innovation manager does not get bureaucratised – they must have freedom to move around the organisation and to challenge directly those practices that could be changed.

They will need to prepare brief reports for the chief executive and the idea proposer to explain what has been tried and done and to what effect.

Conclusion

Many "creative" organisations arrange things so that those who want to try out something new can do so outside the "normal" organisational arrangements (e.g. in "skunk works"!).

Health care is not always seen as involving creativity and innovation despite the technological advances of medicine. What we are proposing is the view that there is considerable scope for innovation in the way things are done, and that the elements of the "scope" are in the minds of the key "face" workers – normally doctors in training. However, there are many reasons why the potential for improvements is never articulated, let alone realised. We believe that an "innovation manager" could save their costs many times over by being a collector and implementor of the ideas for improvements and cost reduction produced by these key "workers".

Robin Gourlay