An intensivist’s perspective | Association of Anaesthetists

An intensivist’s perspective

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 improvements.

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 work.

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 new problems 
  • Transparency: job planning, expectations and an open culture 
  • Flexibility: recognition that we all have lives that change over time. Does your department flex?

Chris Mowatt
Consultant Intensivist and Anaesthetist
Shrewsbury and Telford Hospitals