Article Text

Article 2. Strategy to every day operational management
  1. J Wardrope,
  2. S McCormick
  1. Department of Accident and Emergency Medicine, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK
  1. Correspondence to: Mr Wardrope (Jim.Wardrope{at}northngh-tr.trent.nhs.uk)

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Feedback

The question about weekend waiting times will be discussed in the next edition. However, there are some things that will not wait, complaints for example should be dealt with promptly. The full replies are listed on the internet pages for this month. In summary Dr York felt that the accident and emergency (A&E) staff acted appropriately (see internet pages for answer from the consultant and from the chief executive).

You have to ensure the advertisements for the next set of junior doctors (SHOs) are ready as this will not wait. The draft person specification for the SHO and the advertisement are in the internet pages.Emerg Med J 2001;18:222–224

We have asked to meet the chief executive

Time out—introduction

The first article introduced the concepts of the series, gave some baseline information and set initial problems to be answered. However, the series will also call “time outs” from day to day management to discuss important points of management theory or to take a longer term strategic view. This will be done under the headings of strategy, people management, specialist topics, A&E topics and, perhaps most importantly, attitudes.

From the start of your management life it is important to develop a proactive approach rather than a reactive one. This will enable you to take control of your own (and departments) destiny. We will therefore begin by looking at Strategy, this is the process by which we define our objectives, examine the department's current strengths and weaknesses and state where we want to be in five years time.

Time out—strategy

In the first article we defined management as the organisation and motivation of groups to achieve planned objectives. In A&E …

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Supplementary materials

  • SIMS ARTICLE 2: INTERNET IN TRAY
     

    The Internet pages are divided into "feedback" and "in tray". Feedback gives some of the actions taken over the previous management problems.

    Article 2- Internet FEEDBACK

     

     

    Complaint

    Dr. York was very concerned about the complaint and asked Dr. London�s advice. He said to contact the trust�s solicitors.

    ----------------------------------------------------------------

    Dr. York�s reply to the letter of complaint.

    Dear Mrs. Penny,

     

    Thank you for your letter regarding Janice Green. The facts of the case are as follows. Ms. Green was booked in at 16.50 on 4th January 00. She was assessed and placed in triage category 3 in view of her learning problems. She was seen by the doctor at 18.15 who obtained a full history of a fever and feeling generally unwell. Examination revealed no specific problems but the case was discussed with a senior. It was thought that meningitis was a possible diagnosis among others such as a Urinary tract infection or a viral infection. Various tests were sent. Antibiotics were given and the patient referred to the Medical Registrar. I suggest you write to the medical consultant of that day to obtain his views. The nursing staff did receive a phone call from Mrs. Green and queried the diagnosis but were told that Janice could go home.

    All the staff of the A&E department were concerned and saddened by the news that Janice had died. However I think we can assure Mrs. Green that the A&E staff did all they could to reach the correct diagnosis. The signs were not typical of meningitis and there were other possible causes for the fever. However the A&E staff did start the appropriate treatment and did refer Janice to the appropriate specialty. The A&E department cannot be responsible for the decisions made by other staff.

    If Mrs. Green would like to discuss the case I would be happy to make an appointment to see her.

     

     

    Yours sincerely

     

    Dr. York

    --------------------------------

    Chief executive reply to complainant.

    Dear Mrs. Green,

    Thank you for your letter and I am sorry to hear of your concerns and these have been investigated with Dr. York the A&E consultant, Dr. White the Consultant Physician and Sister Oak the senior sister in the department.

    I understand that you daughter did come to the A&E department feeling unwell with a fever. The A&E staff performed a full examination and one doctor did think that meningitis was a possibility. However the signs were not typical and this has been confirmed by both Dr. York and Dr. White. Dr. York thinks that the A&E staff acted entirely appropriately.

    Dr. White confirms that Janice was fully examined by the medical registrar. He found no signs of meningitis nor any suggestion in the notes that this was suspected. Meningitis can be a difficult diagnosis. The staff involved very sorry to hear of Janice�s death.

    If you have any further concerns please do not hesitate to contact Mrs. Penny, Director of Quality on extension 2345.


     

    Recruitment and selection

    PERSON SPECIFICATION. SHO A&E.

    CHARACTERISTIC

    ESSENTIAL

    DESIRABLE

    BONUS

    MEASURE

    EDUCATION

    MEDICAL EDUCATION UNIVERSITY RECOGNISED BY GMC

    ATLS/ALS EVIDENCE OF CONTINUING PROFESSIONAL DEVELOPMENT

    ENGAGED IN STUDY FOR HIGHER QUAL.

    CV INTERVIEW

    QUALIFICATION

    MEDICAL DEGREE

     

    FIRST PART HIGHER EXAM

    CV

    EXPERIENCE

    6MONTHS MEDICINE AND SURGERY. AT LEAST SIX MONTHS IN RECOGNISED TRAINING POST

    6 MONTHS POST REG EXPERIENCE

    PREVIOUS A&E WORK

    CV INTERVIEW

    PERSONAL

    EXCELLENT COMMUNICATION SKILLS. GOOD TEAMWORKING SKILLS

    PUBLISHED WORK

    EVIDENCE TEAM WORK (GAMES/ HOBBIES)

    CV (WRITTEN) INTERVIEW

    OTHER

    ABLE TO WORK FULL SHIFT PATTERN

      

    INTERVIEW

     

     

    ----------------------------------------

     

     

     

    ADVERT

     

    SHO ACCIDENT AND EMERGENCY- 9 POSTS
    ST. JUDE�S HOSPITAL.

    We invite applications for our SHO posts in this forward looking department seeing 65,000 new patients per year. Excellent rota and very good training program with elements of ALS/ ATLS teaching. Further information from Dr. York A&E consultant (0194 271 4870). Application forms from personnel department.

     


     

     

    ARTICLE 2 - INTRAY

     

    Strategic planning.

     

    TASK- Do SWOT/GAP/STAKEHOLDER ANALYSES

    Complaint

    INFORMATION- Reply from complainant to chief executives letter

    Dear Ms. Butcher,

     

    In reply to your letter you seem to be saying that it is acceptable for your staff to send out a young woman with meningitis I do not agree.

    I was told that meningitis was a possible diagnosis. Why did the medical doctor not do anything to check this? I am still convinced that staff did not take this seriously due to Janice�s learning problems.

    Mrs. Green

    --------------------------------------------------

    INFORMATION- Letter from Mrs. Penny to Dr. York,

     

    Please could you give your further views on the issues raised by Mrs. Green.

    --------------------------------------------------

    TASK- Investigate further, list actions, formulate letter of reply.

     

     


    Orthopaedics

     

    INFORMATION- Letter from Mr. Glasgow, Orthopaedic consultant

    Dear Dr. York,

    I saw yet another patient in the fracture clinic today who had a plaster of paris applied for an undisplaced distal radial fracture. This commonly happens and I am sure you are aware that even for undisplaced fractures it is essential to have a check x-ray after the plaster has been applied.

    Please tell your staff this is essential.

    TASK- List action taken/formulate reply.


    SpR Training

    TASK- What action are you going to take over the training committee report?

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