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Article 4. Team structure, waiting time and a psychotic patient is banging on your door
  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}

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The SWOT analysis has set a large agenda and the direction of the department. The internet feedback contains a project plan along with an example of a delegated operational plan (weekend waiting time). This is a critical part of strategic planning and a step that is often neglected. However, this process reveals the priorities, the resources required and helps plan delegation to other members of the team. It is not possible to do everything on your own. The operational plan sets out in some detail the process that will achieve the objective and sets out the targets for the manager.

This process of Management by objective1 is a powerful tool that gives clarity, form and performance targets for both the manager and the person who is being given the “lead” in delivering the results. SpRs should all be familiar with this process as they should have an educational plan made at the start of their training (strategic plan), yearly objective setting (operational plans) with three to six monthly reviews of progress.

Replies to the complaint letters about waiting time are given along with a letter to the deputy chief executive. One of the complaints was about Dr York. This is always a significant event. Dr York has acted correctly in asking a colleague's advice. This achieves a number of different results. Firstly, and most importantly, it gives the opportunity to talk about the matter. Internalisation of feelings of anger/guilt/ frustration/fear is unhealthy. Sharing these is an important part of staying sane! Secondly, it will bring some objectivity to bear on the response. Denial and self justification are natural reactions but also a sense of guilt might lead to errors in answering the complaint appropriately. Lastly, there may an underlying problem that needs further attention. This complaint was about attitude …

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