What makes a good department? An intensivist’s perspective
Everyone wants a happy workplace. It’s good for us and the
organisations we work for, and of course our patients. In Industry
the value is recognised with annual ‘Best companies to work
for’ lists, backed up by rigorous standards and uncompromising
research. In healthcare, likewise we know that well-functioning
teams are likely to produce higher quality patient care. Everyone
on rotational placements knows the ‘toxic’ environments to avoid.
What do we want, what would perfect be? I would suggest:
interesting, challenging work in a place where collaborative
working is promoted; a place where careers thrive, individuals
blossom and there is a shared investment in high quality patient
care; a place where everyone is valued.
Easy to list, but in practice how could we create the perfect workplace?
Leadership: leaders are key and must have the trust of their
colleagues. The building blocks of trust are respect, credibility
and fairness. The very best leaders I have had listen carefully, do
what they say, and treat everyone even-handedly. In business
these 'For All' leaders use trust to cultivate strong bonds
within the team and connect everyone to the mission of the
organisation. For this to be really successful, the tiers of senior
management need to have this drive as well.
Agency: in good departments, individuals are given the agency
to respond to problems, and innovate by finding novel solutions.
An anaesthetic department will be full of brains, and there is
nothing more frustrating than the head-wall interface when trying
to solve a problem. Frustration, despair and then apathy are
likely to follow. Adobe have a good way of promoting innovative
working. They provide employees with ‘kickboxes’, these contain
guidance on developing new ideas and $1000 in seed money;
what’s more these are available to all employees - no questions
asked. Good departments support innovative thought and
promote quality improvement initiatives. It is human nature to
want to create and contribute. Companies that are more inclusive
in their innovation activities are likely to increase revenue five
times faster. Would we see similar gains in healthcare?
Overcoming negativity: it’s very difficult to work in a ‘failing’
Trust or one that ‘requires improvement’. There can’t be many
hospitals that haven’t seen any negative press, which can have
an impact on recruitment and retention. Worcestershire Acute
Hospitals is one of these, a place I was very happy to call home
for six years of consultant life. And yet the recruitment of great
trainees was never a problem, the department was happy. At
the heart of this success in the midst of systemic failure was total
transparency. There was no hiding place, and the truth of the
problems was shared openly. Individual’s reactions were viewed
as possible solutions, leading to a positive perspective for future
Values: too often ‘values’ can seem a bit glib and meaningless
- an avatar of trite corporate-speak. Upholding sometimes
well-meaning values can be difficult when times are tough. What
does ‘We value respect’ or ‘Together we achieve’ mean in the real
world? Good departments uphold these values, and aren’t afraid
to question each other.
Togetherness: at times an individual’s relative contribution is likely
to vary. Young children, an illness or family concerns can all drag
our attention from the workplace. Medicine is just a job like any
other, sometimes it’s okay just to turn up to work and do a good
job. Supportive departments with a flexible, creative approach
to job planning recognise this variation in our lives. At times an
individual’s contribution will be greater. Valuing each other’s
contributions, celebrating success, and having an environment in
which failures are opportunities, is much more likely to yield joy at
Can you tick all the boxes?
- Leaders who listen, do what they say and act fairly
- Innovation: the ability for anyone to try creative solutions to
- Transparency: job planning, expectations and an open culture
- Flexibility: recognition that we all have lives that change over
time. Does your department flex?
Consultant Intensivist and Anaesthetist
Shrewsbury and Telford Hospitals