Search results

The purpose of this paper is to investigate a boundary spanning, interprofessional collaboration between advanced practice nurses (APNs) and junior doctors to support junior doctors’ learning and improve patient management during the overtime shift.

A mixed methods evaluation of an intervention in an adult tertiary referral hospital, to enhance interprofessional collaboration on overtime shifts. Phase 1 compared tasks and ward rounds on 86 intervention shifts with 106 “regular” shifts, and examined the effect on junior doctor patient management testing a model using regression techniques. Phase 2 explored the experience of the intervention for stakeholders. 91 junior doctors participated (89 percent response rate) on 192 overtime shifts. Junior doctors, APNs and senior medical professionals/administrators participated in interviews.

The intervention was associated with an increase in self-initiated ward rounds by junior doctors, partially explained by junior doctors completing fewer tasks skilled nurses could also complete. The intervention significantly reduced doctors’ engagement in tasks carried over from day shifts as well as first year (but not more experienced) junior doctors’ total tasks. Interviews suggested the initiative reduced junior doctors’ work pressure and promoted a safe team climate, situation awareness, skills, confidence, and well-being.

Junior doctors overtime shifts (5 p.m. to 11 p.m.) are important, both for hospitals to maintain patient care after hours and for junior doctors to learn and develop independent clinical decision making skills. However, junior doctors frequently report finding overtime shifts challenging and stressful. Redesigning overtime shifts to facilitate interprofessional collaboration can improve patient management and junior doctors’ learning and well-being.

The purpose of this paper is to re‐frame perceptions surrounding junior doctors' capacity to contribute to patient safety and quality improvement.

A targeted literature review was conducted followed by individual telephone interviews and a half‐day forum involving junior doctor representatives and selected leaders in the sector.

Junior doctors' entry into health care is an ideal time to cultivate practitioners' interest and expertise in improving the health system for better patient care. Junior doctors are more likely to bring or embrace new ideas, and recognize the importance of transparency and integration of technology into healthcare systems. Engaging with junior doctors in collaborative processes, rather than focusing on their more senior colleagues, may create a more effective culture.

The attributes of junior doctors (as they are in the absence of specific quality improvement or leadership training) that are currently underutilized in patient safety and quality improvement are explored, along with the factors limiting and facilitating the utilization of these attributes.

A postal questionnaire survey of junior doctors’ views was conducted in a large acute hospital in the south‐east of England, amongst 146 junior medical staff recorded as being employed by the Trust across 21 specialities. It profiled their level of participation in audit and the quality of current audit programmes within their specialities and assessed their knowledge and understanding of clinical governance. Our findings suggest: a high level of involvement in activities labelled audit, but that these activities did not necessarily conform to robust audit methodologies; that junior doctors’ professional attitudes towards clinical audit are influenced by negative experience of undertaking audit within their specialities; and that there was a variety of understanding about the principles and meaning of clinical governance. It concluded that the conditions for coherent strategy aimed at promoting effective audit programmes which could support the use of clinical audit as a tool for continuous professional development are not yet in place across the Trust.

The purpose of this paper is to examine the personal views and experiences of Foundation Year 2 doctors operating under the European Working Time Directive (EWTD).

In total, 36 Foundation Year 2 doctors from a single UK-based Deanery participated in this semistructured interview study.

Findings indicated that Foundation doctors typically welcomed a regulation of working hours, but reported frustration at the manner in which the Directive had been implemented. Participants reported concerns at reducing hours by removing out-of-hours working in order to meet EWTD requirements. Out-of-hours shifts were highly valued owing to their increased opportunities for autonomous clinical decision making. By contrast, day-shifts were regarded as heavily administrative in nature and were perceived as service provision. Foundation doctors discussed the unique nature of the out-of-hours working period which appeared to provide specific learning opportunities as doctors draw on time management and prioritisation skills.

Given the challenges the EWTD presents, careful rota planning is essential. First, the authors would encourage the restructuring of day-shift work to provide a greater emphasis on hands-on skills experience in a supportive, supervised environment. Second, where possible, Foundation doctors might benefit from the opportunity to engage in some out-of-hours working, such as with multi-professional “Hospital at Night” teams. Third, the authors would encourage junior doctor involvement in rota design and planning which may increase their perceived autonomy and therefore buy-in of working practices.

Doctors are more likely to suffer from mental illness in comparison to the wider population. This is particularly true for junior doctors, who are at increased risk in comparison to their senior colleagues. This study aims to identify whether junior doctors in North London are comfortable discussing mental health problems with their peers and supervisors and to compare how comfortable they are discussing mental and physical health problems.

An anonymous online questionnaire was designed with demographic data, multiple-choice questions and free-text boxes. This was distributed via email to core psychiatry trainees and foundation doctors in North London. Drug- and alcohol-related disorders were excluded from our definition of mental illness in this survey, as these are reportable to the General Medical Council.

A total of 51 junior doctors responded to the survey. The respondents were significantly more likely to discuss mental health problems with their peers in comparison to their supervisors. They were also less likely to discuss mental health problems in comparison to physical health problems with their peers, supervisors or general practitioner. Qualitative analysis of the free-text comments elucidated several themes including the stigmatisation of mental health.

To the best of the authors’ knowledge, there has been no prior research in the UK comparing the attitudes of junior doctors towards physical and mental ill-health. The questionnaire highlights the continued stigma towards mental health within the medical profession. The difference in attitudes towards physical and mental ill-health has important implications for the training and well-being of junior doctors.

Finding a balance between the provision of quality individualized care and the ongoing education of junior doctors had been flagged as a concern at a large National Health Service (NHS) teaching hospital in the north of England. In response to this, the organization introduced an intervention designed to improve educational culture by providing support to educators, leaders and clinical staff.

This paper features themed results from eight in-depth interviews with educators, consultants and junior doctors to describe and evaluate the process and impact.

Factors that contributed to a positive educational environment included trainees and educators feeling valued, the presence of supportive leaders and the provision of a safe space for learning. Perceived barriers included time constraints, differing motivation and the generic format of formal education. Participants reflected on how the Wrap Around project helped improve the workplace educational culture and offered suggestions for further improvement including the provision of ongoing feedback to learners about their performance.

Research aimed at recognizing and resolving the perceived tensions between the priorities of education and health-care delivery has been flagged as a gap in the literature. The authors argue that developing and enhancing collaborative leadership and educational culture within an organization can reduce these tensions for those working on the front line. Future work should focus on addressing the perceived distinction between the two within services.

Discusses an audit of communications between doctors and other professional groups in a National Health Services trust hospital. The project was undertaken as a result of senior management’s perception that there were problems regarding the interface between professionals and junior doctors particularly, and that these have a potentially detrimental impact on patient care. The aim of the study was to improve the work environment of medical practitioners and professional staff by researching the factors affecting communication and the sources of conflict which exist between the groups. Describes the methodology and provides an overview of the main findings grouped into themes. A large number of recommendations for change have been made to the hospital concerning systems, procedures, structures, training and inter‐professional boundaries. Implementation of some of these recommendations has taken place already. Full evaluation of their impact is yet to be determined.

This paper aims to report on a project undertaken in order to identify, develop and reflect on the leadership and managerial skills of clinicians. The main aim of the project was to design, plan, organise and deliver a learning session for Foundation Year 2 Doctors within the premises of one of the largest NHS Foundation Trusts in the UK. The key theme of the learning session was the introduction of the notion of competent medical leadership in the NHS. A leadership role has been traditionally seen as the task of managers and as such clinicians have seemed reluctant to engage.

A two hour workshop was designed and delivered with the use of Open Space Technology. Foundation Year 2 doctors were invited to consider the importance of leadership in their everyday roles. An awareness of the Medical Leadership Competency Framework had been a key aspect of the learning session.

The project's outcome can be identified as being the encouragement of Foundation Year 2 doctors in considering their roles as leaders in their everyday tasks.

Design, planning, organisation and delivery of a two hour Open Space learning session with the Foundation Year 2 doctors portrays the session's learning potentials and the potential for such sessions to provide a platform for difficult discussions in the NHS. This is particularly beneficial where a cultural shift is needed in order to see a way forward, notably when facing significant change.

This paper aims to demonstrate how lean tools were applied to some unique issues of providing healthcare in a developing country where many patients face challenges not found in developed countries. The challenges provide insight into how lean tools can be utilized to provide similar results across the world.

This paper is based on a qualitative case study carried out by a master’s student implementing lean at a hospital in India.

This paper finds that lean tools such as value-stream mapping and root cause analysis can lead to dramatic reductions in waste and improvements in productivity. The problems of the majority of patients paying for their own healthcare and lacking transportation created scheduling problems that required patients to receive their diagnosis and pay for treatment within a single day. Many additional wastes were identified that were significantly impacting the hospital’s ability to provide care. As a result of this project, average outpatient wait times were reduced from 1 hour to 15 minutes along with a significant increase in labor productivity.

The results demonstrate how lean tools can increase value to the patients. It also provides are framework that can be utilized for healthcare providers in developed and developing countries to analyze their value streams to reduce waste.

This paper is one of the first to address the unique issues of implementing lean to a healthcare setting in a developing country.

This exploratory study aims to explore the perceptions and experience of women doctors on working with each other and draw attention to their ‘voice’ on this issue. The equivocal and limited nature of relevant literature piqued our curiosity on how women perceive working with each other in work settings, particularly within the medical profession.

Twelve women doctors within Australian public hospitals were interviewed through semi-structured informal interviews to “voice” their experiences and views on the comforts and discomforts of working with other women doctors. Their responses were compared to literature to determine similarities and uniqueness of their experiences to women in other settings.

Insights from the respondent’s perceptions and experiences highlight several constructive and negative aspects of working alongside women doctors. Social and psychological constructs of being a “woman” and being a “woman doctor” as well as systemic/cultural issues of the medical fraternity formed how the women in this series of interviews perceived and related to the women doctors they worked with.

This exploratory provides initial insights into the experiences of women doctors on working with each other. Many themes identified have been explored in other settings. Hospital as a workplace, presents many similar work dynamics when considering the work interactions of women in other settings. This study should be used to drive more rigorous enquiry and a larger sample size.

The working relationships women build with each other influence individual careers and organizational outcomes. Understanding the dynamics that improve and hinder the development of constructive work relationships between women can strengthen women-focused managerial and organizational policies and practices.

The consolidation of literature coupled with the exploratory insights of this research contributes to a limited depth of existing literature not only in the medical profession, but in other industries and settings as well.