Agents for Change @agentsforchange - Tumblr Blog

Judgement day approaches...

With 6 days to go, I find myself reflecting on the time and effort we’ve contributed into making sure this conference goes well. At this point, we, as the organizing committee can only hope that this is a success and more importantly, that it was useful and enjoyable for all the delegates. Planning this conference has been demanding but fortunately, rewarding as well. I won’t bore you with the details of every step we had to take, but I think it’s probably more useful to reflect on the lessons we’ve learnt in planning this; a so-called ‘How to’ guide. The first thing you need is a clear and shared vision of what you’re trying to achieve. When we first took on these roles, the challenge was to do something different: we wanted to organize a conference for doctors in training that was fun, exciting, and useful. Things have certainly evolved since then, but we have tried our best to uphold that. Next, you need a good chairperson and a good team. We were very fortunate to be have Dr Marc Wittenberg at the helm of our ship, and we have benefited from his excellent leadership skills. We have also been very lucky that our team has been extremely committed and worked really hard in planning this conference. We have all sacrificed a great deal of our time and effort into this and I want to take this opportunity to give ourselves a pat on our backs for our dedication. These may sound really obvious but through this experience, we have learned that if we have all the above, everything else becomes a lot easier. Throughout the year, there have been many challenges thrown at us, bumps we’ve experienced along the road as well as crises that threatened to derail everything we were working for. We would never have been able to overcome that, if we didn’t have a great leader, a good team and a shared purpose. As for the strategy, that was a lot more straightforward. You need a clear plan of what needs to be done, who’s doing it and when it needs to be done. With a good team, we discovered that the rest will fall in place. One of the other things we have learnt this year is dealing with conflict. Inevitably, in every team, you will have different people, from different backgrounds who have different views. While I won’t profess to be an expert on conflict resolution, I certainly have had my fair share of dealing with it and negotiating an acceptable solution. At the end of the day, it is imperative that we remember that we are all trying to achieve the same goal (cue the need for a clear and shared vision) and have the same purpose. We’ve gained a great deal of experience and skills through this process. There have been times where it feels like pulling teeth, but there have also been times where it’s been a thoroughly enjoyable process. We hope to take these skills back to clinical practice and put it into good use towards shaping a better NHS. After all, we are the agents for change.. @jeanwang82

Agents for Change- A Call to Action

It's just a couple of weeks to go until the Agents for Change 2014 conference, the biggest national medical event for trainee doctors, by trainee doctors, and it’s being held on 26-27 June at BMA House in London.

This year, the theme is ‘Right Skills, Right Team, Right Now’. What does that mean? It means equipping trainee doctors with the capacity and capability to make healthcare better. This might be quite a grand statement but as Sir Bruce noted in his report on the 14 hospitals, “trainee doctors are our most powerful agents for change.”

For me, this means that there is an expectation from the system, and particular from patients, that trainee doctors need to step up and make change happen to secure the future of high quality healthcare. This means constantly questioning the norms, not accepting the status quo, and making the business of quality improvement part of our daily work.

Many trainee doctors are already doing fantastic work around the country, working above and beyond to improve patient care. It is worth taking a look at the new Pubmed-indexed open-access BMJ Quality Improvement Reports journal [http://qir.bmj.com] to be inspired and get ideas:

Improving the accessibility of trust guidelines for juniors doctors. BMJ Qual Improv Report 2014;3: doi:10.1136/bmjquality.u202211.w1101

Instituting a block room for regional anaesthesia BMJ Qual Improv Report 2014;3: doi:10.1136/bmjquality.u204061.w1769

Signposting GP trainees to learning opportunities BMJ Qual Improv Report 2014;3:1 u204199.w1828 doi:10.1136/bmjquality.u204199.w1828.

Agents for Change is In its 6th year now. This will be the first two day event and will include video and poster entries, both of which will be published in a special BMJ QIR supplement. All delegates will also get free access to BMJ Quality, which will enable them to undertake QI projects and submit their own work for publication.

We also have key-note speakers by top medical leaders including Dr Fi Godlee, editor-in-chief of the BMJ, Sir Bruce Keogh, medical director of NHS England, Professor Ian Cummings, CEO of Health Education England, Sir Mike Richards, Chief Inspector of Hospitals, Professor Mahmood Adil, professor of value-based healthcare at Department of Health, and Dr Jennifer Dixon, CEO of the Health Foundation.

In addition, we are delighted to welcome world-renowned speakers from the US and Ireland: Dr James K Stoller will give a perspective from the Cleveland Clinic, one of the most reputable institutions in the world, and Margaret Murphy will offer a deeply moving and personal view of patient safety as one of the WHO’s patient safety envoys.

The Strategic Advisory Board, made up of fellows from the National Medical Director’s Clinical Fellow Scheme, together with BMJ colleagues are working hard putting the finishing touches to the programme, sorting last minute logistics, and compiling the abstract supplements, amongst other things. This is all to ensure that the conference is the best that it has ever been.

We hope that by attending the conference, trainee doctors will be inspired to go back to their workplaces and put this into reality. Through a series of expert workshops, delegates will acquire some of the skills and connections that they need. For example:

Getting the Right Skills in leadership, human factors, influencing others and coaching

Building the Right Team through networking with HEE, FMLM, DAPS and iwantgreatcare.com

Being inspired to start Right Now with the NHS Change Day team and Inspire Improvement project team

To paraphrase Don Berwick, doctors need to both do their jobs and also work to improve their jobs by improving the systems they are working in. In order to do this, and to be taken seriously, we need to have the ability and the confidence to make change happen.

Places are going fast, so register today at http://www.agentsforchange.org.uk then follow us @agents4c and on http://www.facebook.com/groups/agents4c/

@docmarcw

Dr Marc Wittenberg is an anaesthetic registrar and Clinical Fellow at the BMJ and NHS England as part of the National Medical Director's Clinical Fellow Scheme. He is also chair of the 2014 Agents For Change steering committee.

#agents4c

Mobile Health- what is going on right now and what do doctors and patients actually want. A very interesting infographic from mobilehealthnews.com

#agents4c #mobile health

Who are we, and what can we do?

I am going to preface this blog with two warnings. The first is that I am straying dangerously into territory that I am not sure I have any real understanding of. This has never been an impediment to me offering an opinion before (see previous blog) but it is an important caveat. The second issue is that you may not like what I am going to say. And that is fine. And if you don’t like it, please comment as to why. After all, stimulating discussion is what this is all about. So, lets start out with the first part of the question. Who are we? Well, we are doctors. And we are trying to make a change (hence agents for change). But what is a doctor? To the person on the proverbial clapham omnibus, a doctor is a person who is trained in medicine, has life saving skills, and is generally a good egg. But let me put it another way. A doctor is a person trained at medical school, for 5 or 6 years, from leaving school, in medicine. Again, you might think nothing wrong with that. Both are pretty favourable to our position. But lets challenge that. Doctors are responsible for a vast proportion (and the exact figure escapes me) of discretionary spend in the NHS. By discretionary spend I mean spending on diagnostics, therapeutics, surgery etc. As a professional group we make the overwhelming majority of decisions that lead to such spending. We also make up a not inconsiderable proportion of non-discretionary spend in the form of salaries. Let’s now revisit my description of a doctor, trained at medical school, in medicine. I ask, and I am fairly sure of the answer, when were you taught about the NHS? When were you taught about being an employee? I would contend that this is not a huge part of the curriculum! If you think these sound like silly questions, go and ask your friends from university that are in the city when they got taught about it, and the answer will be on day 1 of employment. Corporate values, ‘dos’ and ‘don’ts’ would have been explicitly laid out in day 1. We are highly trained, and we are prepared to take on and analyse risk in ways that other professional groups have not been trained to do. Medicine is a hugely demanding course. But that should not blinker us to the fact that as employees, as parts of the system, we can frequently be the problem. We simply are not that special in the system. Once upon a time to get an ACEi started you needed to be in hospital. This is now done in primary care. Similarly, a lot of medical roles are now non-medical, emergency nurse practitioners for example. I am not justifying or apologising for these roles, but there is sometimes a professional arrogance on the part of doctors that can be hard to justify about the progress that this may represent. It can be viewed as a threat. I do not want this to come across as negative. The fact that you have got so far in reading this means that you are prepared to take on an opinion which I fully accept may be at odds with your own. The point I am trying to make is that our detachment and our superiority may sometimes be the very barriers to change which we ourselves seek to break down. We have to question why we are against the change.. This is going to be an anathema to some, but a corporate vision is in my view useful, A single goal, or group of goals, shared by all, where the doctors, nurses, AHPs, ODPs and everyone else is working towards the same vision, not fighting over a imagined turf war. No one ever prepares junior doctors for statements like that. They are incongruent with our notion of medicine, and I am sorry to say it sometimes our notion of academic superiority How does this get resolved? In my view, the answer is that we need to develop a little bit more refelection. I would ask that we, as a group reflect on how others may perceive us when we go around trying to effect change. I would like to think that when I talk about QI, or reflect on lessons learned, that I give due consideration to how others might view my position. I am in the very fortunate position of being an anaesthetist. I have a very long list of ODPs that I cannot thank enough for helping me out, humbling me, and making sure that frankly I got my sh*t together. Most of them on half my salary and with twice my experience. I will wager that there is not an anaesthetist worth their salt who has not got several ODPs to thank. I know I need to get on with them, so I do. But what about the ward nurses or midwives. I reckon that frankly I could sometimes do a better job. But I know that if I want to go back into the hospital in September and start a QI project, these are the very people I will need to help me, so I need to share their vision, and they need to share mine so wouldn’t it be easier if we all shared it to start with? @DrThomasDuncan The man who now needs to make friends with a great many nurses and midwives is Dr Thomas Duncan, an anaesthetic SpR and Clinical Fellow at NICE as part of the National Medical Director's Scheme

Some cold, hard facts about weekend death rates from dr foster. We may not like it from a lifestyle perspective, but 7 days services can only be a good thing.

#drfoster #agents4c

Carpentry of the Mind

What is a typical leader? Strong minded, analytical and outspoken? Well I believe that there is no typical leader and we should not try to fit the mould but use the personal qualities that we have and develop the ones we don't. This blog is by way of an explanation of why (and how) I an orthopaedic registrar came to work in a secure mental health facility. In an attempt to convince some of you unlikely leaders and managers to forget what you have been told in the past I want to explain a little further …

Take my 4 year old, in a conversation I overheard with her friend, Duncan, which went something like this:

Duncan: can I tell you a joke?

Lottie: yes

Duncan: why is Cinderella no good at football?

(Without even pausing)

Lottie: because she's a girl…

Apart from ruining the joke this sent her friend into a 20 minute sulk. Now I'm no feminist but it took me by surprise that my 4 year old is coming out with this and I can honestly say that I have not knowingly encouraged or engendered this sort of attitude. I'm not sure if there is a particular point at which we start saying ‘I can’t because I’m (insert perceived negative attribute here)’.

This brings me to my point (which is not just to express disappointment in my progeny) that somehow through life we begin to perceive parts of our personality as limiting factors or worse, how others perceive our attributes and we begin to mirror these in our own behaviour. You can see this in all aspects of society, whether it’s sexism, racism or in the typical medical hierarchy where somehow a junior doctor’s ability to have any positive effect on the system is traditionally limited by their chronological level of medical training. In this insular world, experience outside of medicine doesn't count, and that somehow your judgement is automatically impaired from the first day at medical school until the day you get your CCT. In short we have been led to believe that as doctors we have no ability to change or improve the system for the benefit of our patients.

Then what makes a typical leader? Take for example leaders and their Myers‐Briggs Personality Types. There is a predominance of ‘Thinking Judging’ types among managers; over 80% have this personality type – possibly due to a degree of self-selection. Now mine is an ‘Introverted Sensing Feeling Perceiving’ type and we rare species make up <1% of the management population. Not the 'right' type to be a leader you might think. Incidentally it lists my preferred job as ‘carpenter’ (I don’t fail to see the unfortunate irony of my career choice as an orthopaedic surgeon).

If the results were applied to me it probably means I am no good as a manager. Unfortunately at the time I had just started as one of the National Medical Directors Clinical Leadership and Management Fellows apparently having shown some promise during the interviews. Luckily for us ‘Perceiving and Feeling’ types subsequent research has somewhat discounted the application of the MBTI as a selection tool and now the theory of ‘Emotional Intelligence’ (EQ) is seen as one of the biggest contributors to success, not your MBTI or even your IQ and, wait for it, EQ can be learned.

In simple terms this means understanding ourselves, what makes us tick, and applying what we know to learn new ways of controlling our responses to particular situations. I believe that there is no typical leader and we should not try to fit the mould but use the personal qualities that we have to the best effect and develop the ones we don’t.

Whatever flavour of doctor we choose to be, we have a big part to play in the future of our health services, starting right now. I have been working at St Andrew’s for 6 months and I don’t have any regrets about choosing this path, having collaborated with other like-minded individuals who just happen to be psychiatrists.

Do not believe for one second that we can't do something because we lack particular attributes or that 'this is the way that that things are done around here'. We should all try and think a little differently and convince our senior colleagues to think differently too by performing a little ‘carpentry of the mind’. Don't accept that you can't change things; challenge the norms and do something brilliant. This is the reason why I, an introverted orthopaedic surgeon, ended up working as a leadership and management fellow at a mental health charity.

N.B. Having prised the answer out of my daughter’s friend, the correct punch line to the joke is 'because she keeps running away from the ball'.

@geordiebones

Dr Carl Fenton is an orthopaedic registrar, amateur psychiatrist (and unlikely leader), currently serving as Clinical Fellow at St Andrew’s in Northampton as part of the National Medical Director's Clinical Fellow Scheme

#agents4c

Speak up for a change

The fairest comment I think ever made of me in an MSF is “Tom is not afraid to speak his mind, which is a refreshing change (most of the time)”. It was made several years ago, by a trusted consultant and I think encapsulates who I am, and what I am about. I’m going to split that statement into two parts and use them as headings for the remainder of this blog. It is a call to arms in many ways, but I also hope it acts as a reminder of why junior doctors, who sit at the real coal face of secondary care, are a vital tool as the eyes and ears of frontline NHS work. If you do not report it, who will?

I hope agents for change can give people the confidence to speak up about issues they face, the knowledge to understand which are the important issues to speak up about speak up about, and help develop the skillset they need to really make a difference.

Not afraid to speak his mind...

I cannot emphasise how important this is. Well I would say that, somebody said it about me, but actually I have had my skin saved, or more correctly, a patient has been saved from a potential error, by somebody speaking up. Maybe it was the ODP asking “are you really sure you want to do that?”, or a nurse offering an observation about my handwashing, or lack thereof. Maybe it was me speaking up about something else. Blame free, appropriate challenge is vital to the functioning of a hugely complex system that involves the interaction of many processes and people.

Speaking up is crucial. We are not afraid to do it amongst our peers. I challenge anyone to go into a theatres coffee room at lunchtime and not overhear at least 5 moans about the day, lists overrunning, equipment problems, delays stroppy staff. You name it, you are likely to hear it. But is that really enough? I put it to you that it is not. When was the last time you filled in an incident form? When was the last time you followed up with the ward and portering staff and theatre staff about why a patient had experienced delays?

What is it that stops us? Part of it is a perception, and it is not a million miles from the truth, that the system is not capable of either listening or responding to our complaints. We spend hours putting data onto a web form, baffled by which directorate the ‘incident’ may have occurred in, for it to be sent off to a list of people you mostly have never heard of, and for you to get no response. Part of it is the sense that junior doctors are no longer part of a team. I was lucky enough to work in a firm when I was an SHO doing medicine. The registrars knew me, got to know what I was good at, and more importantly developed a long term view of some of my weaknesses and could constructively help me deal with them. Changing teams, short rotations, shift work, they all mean that doctors have lost the relationship with the system.

So speaking your mind, at least at a level where you think your views are being heard has become harder. And that is a loss for the system, as it can no longer learn from the mistakes that you are involved with. I ascribe no blame for these mistakes by the way. For many you are simply in the right place to have observed them. But if no-one reports them, or acts on them, and all you do is grumble in the coffee room, how can you expect anything to change?

...Most of the time

So you spoke your mind, and it was wrong. Well, the first thing is that none of us can be right all the time. Watching a consultant teach a registrar in theatre one day I was struck by the expression he used “You are not making a mistake I have not made 100 times myself”. In meeting some of the leaders of healthcare this year I have been struck by just how often they admit they have got it wrong, particularly at the early stages of their career.

This, in part, comes down to politics. Like it or loathe it, managing change is politics, it is dealing with people. You had some grand vision of how a patient pathway should work but hadn’t appreciated the significance of particular part of it, or you made a bad call about somebodies intentions. Well it happens. But as in medicine generally, we are not really paid for when things go to plan, we earn our money when things do not go to plan, and you earn your worth in leadership and management by acknowledging when you have said or done something wrong.

How much better does sorry sound when people mean it?

So you don’t have to get it right all the time, you just have to be honest when you haven’t!

@DrThomasDuncan

Dr Thomas Duncan is an anaesthetic SpR and Clinical Fellow at NICE as part of the National Medical Director’s Scheme

#agents4c

Whilst we're on the subject of public health, here's another eye-opening infographic from the Kings Fund. A BMI over 30 reduces life expectancy by 10 years and liver deaths are on the rise. Good thing tax on beer has just been cut then...

#kingsfund #FMLM #agents4c

Mind your PMQs

Doctors routinely reflect on their experiences and memories - both positive and not-quite-so positive - as ‘firsts’; “the first time I did a LP….”, “the first time I led a crash call….”, “the first time I confirmed a death without screaming because a phone vibrated whilst feeling for pulses…’(No? Just me? ) and so on.

This year has been no exception in creating ‘firsts’ and although the theme of these for the FMLM Clinical Fellows are perhaps less clinical than usual – they are incredible experiences and reflect the breadth of work fellows undertake during their medical leadership and management placement.

One of my ‘firsts’ this year has been drafting answers for Parliamentary Questions (PQs). PQs are a way by which Members of Parliament (MP) can hold the government to account with requests for information or calls for action in order to explain or defend the work, policy decision and actions of their Departments. They are presented as either oral or as written questions. The government is obliged to answer all PQs and the answers are published in The Official Report, commonly known as Hansard. PQs have to be answered promptly and accurately, and each PQ has a single unique Hansard number.

Government departments ask organisations to answer part or all of a PQ and the organisations are obliged to respond, usually within 24 hours. Final answers are sent to the MP or peer who asked the PQ and are published on the Houses of Parliament website.

10 steps for answering a PQ

1. Assess the PQ – is this for you to answer? Do you understand the question? This may sound silly but there have been a few where I’ve struggled to understand questions – and sometimes errors are made, especially when non-clinicians ask detailed scientific questions. This can be tricky and sometimes it’s sensible to answer both the question asked, and also the question you think they meant to ask…. Is any further clarification from the MP/peer needed? Do you need to consult anyone else to answer the question? I’ve had questions where I’ve needed to consult and amalgamate contributions from 8-10 different people and departments, and when you have a short turnaround this really tests your leadership and management skills! Do you have the correctly titled PQ template? Do you know who can/needs to sign it off and are they available to sign off before the deadline?

2. Collect the data and draft the notes - Use routine data outputs, published figures and cleared lines wherever possible because these data are reliable; they have been checked, cross checked and cleared with communications teams before publication. They also ensure consistency in message, particularly for sensitive issues where the wording is so critical to the interpretation.

3. If the question cannot be answered or data requested does not exist, explain why and suggest alternatives – for example, the nearest routine data output with an explanatory note.

4. It is not good practice to introduce new data through the answer to PQs

5. Be concise and keep within the word limit (100 to 150 words for written PQs and 75 for oral PQs)

6. Use plain English and avoid jargon - few politicians and civil servants have a science or health background or knowledge of the subject.

7. You can expand on the PQ answer with 500 words further background information which is available for the Ministers if needed, but may also be published

8. Complete internal checking procedure

9. Complete sign-off procedure

10. Send the draft response to Parliamentary accountability team

References

PHEnet Parliamentary Questions guidance http://phenet.phe.gov.uk/Services/parliamentary-accountability/Pages/Parliamentary-Questions.aspx

About Parliament: PQs http://www.parliament.uk/about/how/guides/factsheets/procedure/p01/

@Dr_CJ_Roberts

Dr Charlotte Roberts is currently Clinical Fellow to Public Health England as part of the National Medical Director's Clinical Fellow's Scheme

#pmqs #FMLM #agents4c

Leadership sans frontieres

Have you ever wondered what healthcare leadership and management was like in another country? As medical leaders we can learn plenty from the established healthcare models in Australia, Singapore, Sweden, the United States and Scotland. Hold on just a minute; did I say Scotland? Yes indeed. Contrary to the prevailing hysteria in London, Scotland is still actually attached to England, and you don’t even need a visa to visit (just a warm coat). Working on the principle of “who dares, wins”, three of the National Medical Director’s Clinical Fellows set off on the red-eye to Edinburgh to find out how things are done “Up North”. To understand any healthcare system, it’s important to have a bit of context. The NHS in Scotland is completely devolved, with responsibility for financing and running services residing within the Scottish Government. The budget assigned to the NHS in Scotland is in the order of £12 billion, for a population of 5.3 million (which is comparatively more generous than the £96 billion allocated to the populous of 53 million in England). During our two-day visit we were hosted by Dr Mike Winter, Medical Director of Procurement, Commissioning and Facilities at NHS National Services Scotland (NSS). We were also joined by the two inaugural Scottish Clinical Leadership Fellows, who have been in post since January 2014. A packed agenda gave us insights into commissioning, public health, adverse incident management and procurement (this session should receive special mention for actually being incredibly interesting, which apparently is not an oxymoron). On reflection, we were totally abashed at our lack of knowledge of a healthcare system that exists a stones throw across an imaginary border (unless, unlike the Barbarians, you count Hadrian’s wall). This was especially startling to our group of clinical fellows, some of whom have made great efforts to understand the nuances of healthcare systems on the other side of the Atlantic. What really struck us during our visit was how integrated the system was. The delivery of healthcare in Scotland has been the responsibility of the 14 territorial and 7 special NHS boards since 2004, and the turmoil of the Health and Social Care Act in England has left Scottish healthcare waters untroubled. Granted, the population is smaller, and the supporting structures and organisations are smaller as a result (it certainly appeared to help that a number of different healthcare organisation teams were based on an integrated site in Gyle). However, what made the organisations we met seem nimble and forward facing was the networks of people they had established. Members of the team from commissioning, procurement and public health knew each other’s roles, their limitations, and how they could support each other to see the bigger picture. This focus on the importance of working together extends to patients and their families too: the “Future for NHS Scotland – 2020 Vision” aims to deliver “fully integrated health and social care with a focus of keeping people out of hospital and in their own home or community as much as possible.” As we approach the first anniversary of the Health and Social Care Act in England, and the creation of NHS England and Clinical Commissioning Groups, we can learn a lot from Scotland’s focus on integration for the benefit of patients. Breaking down organisational barriers can be challenging, but the rewards are well worth the effort. Felicity Taylor

A revealing look at what it costs to keep us healthy and how we stack up against other nations. Source: The Kings Fund.

#fmlm #agents4c #kingsfund

A4C Blog: what do you want to be?

As a profession we are trained to keep our heads down, work hard and expect all to come good in the end. This means different things to different people, but few would deny an ambition for professional autonomy and job security.

The reality though is that healthcare is facing huge challenges and as individuals within that system we have to understand those changes to have any chance of either of those ambitions.

The first challenge is that medicine is becoming industrialised. The conveyor belt of medical training is churning and has been doing so at an increasing pace for over a decade. As this surge in doctors starts to near the end of training it becomes clear that they are not so much the product, but are in fact part of the machine itself. As the population ages and the predictable increase in lifestyle disease takes hold, doctors will increasingly become ‘providers’ with usefulness measured by the number of lists, rounds or clinics that can be attended. Shift work has already become the norm and our working patterns will become dictated by the need to maximise patient volumes.

The second challenge is that the money is running out. After a decade of unprecedented growth, investment into the NHS is now flat. £15-20bn in annual savings have to be found by 2014/15 and funding is unlikely to rise until 2022 at the earliest. As the figure shows (taken from the Nuffield Trust’s ‘A Decade of Austerity’) the main pressures come from pay, chronic diseases and population growth.

The third challenge is public expectation. A year on from the Francis Enquiry we face a public and press astounded by the apparent lack of care and compassion in clinical staff that led to the scandal at Mid Staffs. As the public becomes better informed and better served by other sectors they expect the NHS to care about the service it provides and we are increasingly being judged on the experiences of our patients.

We have a choice when faced with challenges like this. We can roll our eyes at the word ‘scandal’ and wonder if this has all been blown up a bit too much by press and politicians. We can say that lapses of care and patient experience are inevitable given the funding crisis and the relegation of doctor to ‘service provider’. We can leave this to the managers and the politicians and blame them when they get it wrong.

The alternative is that we face up to this. Have you ever walked away from a patient in distress or pain? Did you ever try and find a reason not to see a referral at 4am that you wouldn’t have questioned in the day? How many ways did you justify it? These are not things we would like to admit, but it’s our responsibility to admit they happen and to understand why they happen. Then we can learn how to shape the system we work in to make it easier to do the right thing. The truth is nobody knows how best to balance the expectations of world class care with the pressures we face, but more than any other time since I started training there is a will to listen to doctors in training, to invest in them and to equip them for the challenges ahead. Once you accept that you have a voice and you are as qualified as anyone to comment on the system as it stands you find that you can start to influence and improve it very quickly.

True job security and professional autonomy in the old fashioned sense may be a privilege that few can still be guaranteed, but for those who are prepared to take a risk, who stand up to be counted, there is a world of opportunity out there. Be an agent for change.

Rob Fearn

@robfe4rn

#agents4c #nuffieldtrust

Coming up with a conference theme...

In a scene reminiscent of Twenty Twelve, three clinical fellows sit behind a stack of coffee cups in a darkened room. Four weeks earlier, the Agents for Change committee had hit a creativity wall. Now, with a rapidly approaching deadline and a sum-total of zero usable ideas for a conference theme, Agents supremo Marc (also known as ‘M’) orders the formation of a creative task-force, of the sort to rival Saatchi & Saatchi, but without the Annabel’s bill. Our collective brainpower is legendary, and yet, even with our secret weapon (Steve, who actually was in advertising in his previous life) progress is slow. We have our concept all sewn up; we want the conference to be about forming networks, learning new skills, and emphasising the importance of doctors in training taking responsibility for change now. What we’re having trouble with is the wording. We’ve exhausted our synonyms, and are thwarted in our attempts to access an online thesaurus by the spectacularly useless WiFi reception. Two flip charts stand covered in Steve’s ‘rule of threes’, and ‘team’ and ‘skills’ written repeatedly in different colours to see if they provoke more inspiration in red (they don’t). Rob even tries leaving the room to see if he’s stifling our creativity by his mere presence. Frustration is growing and “Speak. Act. Lead” as a conference theme seems more appealing by the minute… Suddenly Flick has cracked it (well, it may have been Rob, and Steve is definitely claiming it): “Right team, right tools, right time”. Patting ourselves on the back for having succeeded in our quest for alliteration we make a sharp exit to the pu…another meeting. It isn’t until later that evening that the realisation hits that encouraging conference delegates to be “right tools” might not have the desired effect. Undeterred, we make a final heroic effort. The ‘Whatsapp’ feed goes crazy, and in a rare burst of medic creativity our theme emerges. Welcome to Agents for Change 2014: “Right Skills, Right Team, Right Now”. And that was the easy bit…. Flick @felicityjtaylor

Kicking it off!

Welcome to the first in a series of blogs giving you an overview of what is going on whilst we plan for Agents for Change 2014 and some sneak previews of what to expect.

My name is Marc and I am the National Medical Director's Clinical Fellow at NHS England and the BMJ. It traditionally falls to the fellow in this post to lead on the Agents for Change conference and so I have the clearly enviable task of corralling 20-odd rowdy fellows ably assisted by some excellent and professional colleagues at the BMJ, into planning and delivering Agents for Change 2014.

This year, we have kicked off early and my first job was to convene, and chair, our Strategic Advisory Board (SAB). What is a SAB, I hear you say? Well, it's kind of like a committee but with a grander title and certainly this has been positively received by everyone else.

The first thing I realised is that there is a great pedigree: there have been five excellent Agents for Change conferences over the past years and the brand has developed into one that is instantly recognisable and trusted.

The second thing I realised is that we are extremely lucky to have the unwavering support of the National Medical Director, Professor Sir Bruce Keogh, and the Editor-in-Chief of the BMJ, Dr Fiona Godlee, and I am extremely pleased to say that they will both be speaking at this year's conference.

The third thing I quickly realised is that conference organising is not easy - there is loads to do, lots of detail to work out and lots of decisions to make. As I said, we are grateful to be supported by some great people at BMJ, in particular Holly, Sara, Joy and Ashley.

Real success will come from my fellow fellows working together to what we know will be a fantastic event. I am really grateful for their hard work so far and I am learning a huge amount in the process of chairing the SAB.

I have given a lot of thought to my style of leadership (one of the raison d'être of this year) and hope that by facilitating the different work streams and distributing the tasks, we can make this work. In the meantime, Happy 2014 and all the best to everyone over the festive season.

Marc

@docmarcw

#agents4c #NHS #change

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Sir Bruce Keogh, NHS Medical Director

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