Leadership and Management in Healthcare : A Guide for Medical and Dental Practitioners

This book is a comprehensive guide to leadership in healthcare and the management of complex clinical scenarios in the medical or dental practice. Training in leadership and hospital management is not part of the curriculum and so guidance is often not provided in depth. This book outlines strategies for dealing with the management problems that arise in the healthcare profession, and it prepares the reader for interviews, examinations and the supervision of a team. It opens with an overview of the NHS, its evidence-based practice and healthcare regulations. Subsequent chapters discuss data protection, management of new business cases, formal complaints and inappropriate use of social media. Information is provided on the recruitment of new junior trainees, the management of underperforming allied health professionals, and the handling of injuries sustained at work. This book is ideal for final-year medical and dental undergraduate students, foundation year doctors, core trainees, junior and senior specialists and newly-appointed consultants. Preface Junior and Academic Grades Nomenclature Acknowledgements Contents Part I: The Management, Structure and Function of the National Health Service 1: The Structure of the NHS 1.1 Introduction 1.1.1 Funding Streams 1.2 Organisational Structure of the Department of Health (DH) 1.2.1 Secretary of State for Health and Social Care 1.2.2 Department of Health 1.2.3 NHS England 1.2.4 Clinical Commissioning Groups 1.2.5 National Institute for Health and Care Excellence (NICE) 1.2.6 NHS Improvement 1.2.7 Health and Wellbeing Boards 1.2.8 Care Quality Commission 1.2.9 Public Health England 1.2.10 Other Important Organisations 1.3 Hospital Structures 1.3.1 The Board of Directors Further Readings 2: Quality, Efficiency and Value in the NHS 2.1 Introduction 2.2 Quality in the NHS 2.2.1 NHS Improvement Quality 2.2.2 NHS Improvement (NHSI) 2.2.3 Commissioning for Quality and Innovation 2.2.4 Quality Premium 2.2.5 Healthcare Quality Improvement Partnership 2.2.6 National Voices 2.2.7 National Confidential Enquiry into Patient Outcome and Death 2.2.8 Quality and Outcomes Framework 2.2.9 National Quality Board 2.2.10 Patient Reported Outcome Measures 2.3 Efficiency Models in Healthcare 2.3.1 The Lean Model 2.3.2 McKinsey 7S Framework 2.3.3 Kotter’s 8-Step Change Model 2.3.4 Lewin’s Change Management Model 2.3.5 The Congruence Model 2.3.6 The Burke–Litwin Model 2.3.7 Weisbord’s Six-Box Model 2.4 Purpose Further Readings 3: Evidence-Based Practice in the NHS 3.1 Introduction 3.2 NICE 3.3 NICE Decision Making 3.3.1 Clinical Effectiveness 3.3.2 Cost-Effectiveness 3.3.3 Social Value Judgements 3.3.4 Implementing a New Practice Further Readings 4: Healthcare Regulation in the UK 4.1 Introduction 4.2 The Royal Colleges 4.3 Health and Social Care Regulators 4.3.1 The General Chiropractic Council 4.3.2 The General Dental Council 4.3.3 The General Medical Council 4.3.4 The General Optical Council 4.3.5 The General Osteopathic Council 4.3.6 The General Pharmaceutical Council 4.3.7 The Health and Care Professions Council 4.3.8 The Nursing and Midwifery Council 4.3.9 The Pharmaceutical Society of Northern Ireland 4.3.10 The Social Work England 4.4 Requirements for Practising Medicine in the UK 4.4.1 Provisional Registration 4.4.2 Registration for Doctors with European Qualifications 4.4.3 Registration for Doctors with International Qualifications Further Readings 5: Staffing in the NHS 5.1 Introduction 5.2 Recruitment 5.3 Role of Consultants in the NHS 5.3.1 Summary of the Key Roles of an NHS Consultant 5.4 Job Planning 5.4.1 Direct Clinical Care and Supporting Professional Activities 5.5 Appraisals 5.6 Revalidation Further Readings 6: Ethical Practice and Medico-legal Themes in the NHS 6.1 Introduction 6.2 Ethics in Everyday Practice 6.3 Confidentiality and Consent 6.3.1 Consent to Release Information 6.3.2 Authority to Access Confidential Information 6.4 Consent for Treatment 6.4.1 Patient’s Consent to Treatment 6.4.2 Consent for the Use of Human Tissue 6.4.3 Consent for Clinical Photography/Video Recordings 6.4.4 Consent for Fertility Treatments 6.5 Reporting: Duty of Candour 6.6 Proof of Negligence Further Readings 7: Clinical Effectiveness and Clinical Audit 7.1 Introduction 7.2 Clinical Effectiveness 7.2.1 The Stages of Clinical Effectiveness 7.3 Clinical Governance 7.3.1 Research Governance 7.3.2 Non-NHS Research Projects 7.4 Clinical Audit 7.4.1 Classification of Clinical Audits 7.4.2 The Clinical Audit Cycle 7.4.3 Advantages of Clinical Audit 7.4.4 Difference Between Clinical Audit and Clinical Research 7.4.5 National Clinical Audits 7.5 Achieving Clinical Effectiveness Further Readings 8: Trainee Performance and Assessment in the NHS 8.1 Introduction 8.2 The Structure 8.2.1 The Regulators 8.2.2 Postgraduate Training Bodies 8.3 The Process 8.3.1 Pre-CCT Appraisal 8.3.2 Post-CCT Appraisal 8.3.3 National Clinical Assessment Service Further Readings 9: Clinical Risk Management in the NHS 9.1 Introduction 9.2 National Agencies 9.2.1 The NHS Commissioning Board Special Health Authority 9.2.2 The National Clinical Assessment Service 9.3 Serious Incidents 9.3.1 Types of Serious Incidents 9.3.2 Management of a Serious Incident 9.4 Management of a Litigation Case in Acute Trusts 9.5 Risk Management Strategies in UK Trusts 9.5.1 Risk Register Processes Further Readings 10: Data Protection and Freedom of Information 10.1 Introduction 10.2 Confidentiality Code of Practice 10.3 Data Protection Act 2018 10.3.1 Defining Personal Data 10.3.2 Data Protection Aims 10.3.3 Data Protection Principles 10.3.4 Caldicott Principles 10.3.5 Differences Between the Data Protection Act 1998 and 2018 10.3.6 Other Data Protection Principles 10.3.6.1 Information 10.3.6.2 Access 10.3.6.3 Exemptions 10.3.6.4 Security 10.3.6.5 Research 10.3.6.6 Maintaining Standards 10.3.6.7 Information Commissioner Further Readings Part II: Management Scenarios 11: Management of an Underperforming Allied Health Professional 11.1 Introduction 11.2 General Management Principles 11.3 Management Approach to this Scenario 11.3.1 Stage 1 of the Formal Process 11.3.1.1 Outcome of Stage 1 of Formal Process 11.3.2 Stage 2 of the Formal Process 11.3.2.1 Outcome of Stage 2 of the Formal Process 11.3.3 Stage 3 of the Formal Process 11.3.3.1 Outcome of Stage 3 of the Formal Process 11.4 The Appeals Process 11.5 Trust Policies 12: Management of an Injury Sustained at Work 12.1 Introduction 12.1.1 Risk Assessment 12.1.2 Risk Management 12.1.3 Hazard 12.1.4 Risk 12.2 Management Approach to this Scenario 12.3 Legislations 12.4 Trust Policies 13: Management of Clinical Incident at Work 13.1 Introduction 13.2 Clinical Incidents 13.3 Management Approach to this Scenario 13.4 External Reporting 13.5 Trust Policies 13.6 NHS England Legislations for Serious Incident Framework and Never Events 14: Management of Justifying Existing Levels of Care 14.1 Introduction 14.2 Clinical Commissioning Groups and Funding Streams 14.2.1 Funding Formulas 14.2.2 Person-Based Resource Allocator 14.2.3 Current Allocation Strategy for CCGs 14.3 Management Sequence for this Scenario 14.4 Further Reading 15: Management of a Suspected Victim of Physical Abuse 15.1 Introduction 15.2 Types of Abuse 15.3 Signs of Child Abuse 15.3.1 Physical Abuse 15.3.2 Emotional Abuse 15.3.3 Sexual Abuse 15.3.4 Neglect 15.4 Management of Child Abuse in a Clinical Setting 15.5 Relevant Trust Policies 15.6 Legislations 16: Management of a Breach of Data Confidentiality 16.1 Introduction 16.2 Data Protection 16.2.1 Obtaining Consent 16.2.2 When Is Consent Not Necessary? 16.2.3 The Information Commissioner’s Office (ICO) 16.2.4 The National Information Governance Board for Health and Social Care (NIGB) 16.2.5 UK Caldicott Guardian Council 16.3 Management of Loss of Patient Identifiable Data 16.4 Legislation and Typical Trust Policies 17: Management of a Formal Complaint 17.1 Introduction 17.2 Complaints 17.3 Management of a Complaint 17.4 Taking the Complaint Further 17.5 Legislation and Typical Trust Policies Further Reading 18: Management of a Contaminated Needlestick Injury 18.1 Introduction 18.2 Incidence of Needlestick Injuries 18.3 Needlestick Injuries and Blood-Borne Pathogens 18.4 Reducing the Risk of Transition 18.5 Higher Risk Groups 18.6 Protocol for a Healthcare Worker Exposed to High-Risk Blood Sample 18.7 Protocol for a Healthcare Worker Exposed to a Low-Risk or Stale Blood Sample 18.8 Immediate Management of a Sharps Injury 18.9 Occupational Health Service Management of a Needlestick Injury 18.10 Legislation and Typical Trust Policies Further Reading 19: Management of Staff with Repeated Episodes of Absenteeism 19.1 Introduction 19.2 Main Types of Leave Entitlements 19.2.1 Maternity Leave 19.2.2 Paternity Leave 19.3 Management of Colleagues with Repeated Episodes of Absenteeism 19.4 Typical Trust Policies 20: Management of a New Business Case 20.1 Introduction 20.2 Business Cases 20.3 Management of Applying for a New Member of Staff 20.4 Main Sources of Income Generation and Savings within a Hospital Department 20.5 Typical Trust Policies 21: Management of a Dilemma Involving Sharing of Confidential Information and Professional Conduct 21.1 Introduction 21.2 Legal Obligations 21.3 Management of a Colleague with a Blood-Borne Virus 21.4 Management of Scenario 21.5 Guidances, Legislations and Typical Trust Policies 22: Management of a Non-compliant Trainee 22.1 Introduction 22.2 Types of Trainee Assessment Tools 22.3 Management of a Non-compliant Trainee 22.4 Typical Trust Policies 23: Management of Recruiting New Junior Trainee 23.1 Introduction 23.2 Foundation Year Trainees 23.3 Management of Recruiting New Junior Trainees 23.4 Typical Trust Policies 24: Management of Suspected Fraud in Your Department 24.1 Introduction 24.2 Legal Framework 24.3 Management of Suspected Fraud at Work 24.4 Typical Trust Policies 25: Management of Violence and Aggression at Work 25.1 Introduction 25.2 Legal Framework 25.3 Management of Violence and Aggression at Work 25.4 Typical Trust Policies 26: Management of Health Tourism in Your Department 26.1 Introduction 26.2 Legal Framework 26.3 Management of Hospital Admissions 26.3.1 Management of Outpatients Appointments 26.4 Patients from Countries in the European Economic Area 26.5 Typical Trust Policies and Relevant Documents 27: Management of Colleagues Affected by Stress at Work 27.1 Introduction 27.2 Stress at Work 27.3 Stepwise Approach Following Identification of Stress at Work 27.4 Legislations and Typical Trust Policies 27.5 Sources of Further Information 28: Management of Inappropriate Use of Social Media 28.1 Introduction 28.2 Use of Social Media at Work 28.3 Stepwise Management Following Incident 28.4 Legislations and Typical Trust Policies Appendix 1 Appendix 2 Appendix 3 The Glossary