I have just been on the “train the trainers” session for this, run on behalf of the Revalidation Support Team (RST) by Drs Gleek and Bibby. It was good. An amazing amount of work has gone into this and many thousands (hundreds of thousands?) of doctor-hours will go into the process in future. Is it all worth it?
Since doctors who want a licence to practice have no choice, that is, perhaps, the wrong question. A better one would be: how can we make it all worthwhile?
I think that two things that will make appraisal worthwhile are to focus on a developmental emphasis for the doctor and to ensure that every doctor is adequately supported in their day to day clinical work and in their appraisal and the personal development plan that flows from it.
Appraisal with a developmental focus produces the best results. Appraisal with an external performance-management emphasis removes the locus of control to outside the doctor and results in (at best) reluctant compliance.
MOST DOCTORS START OFF THEIR PROFESSIONAL LIVES WITH AN AMBITION TO MAKE THE CARE OF THE PATIENT THEIR FIRST CONCERN. What these doctors need is developmental appraisal that meets all the GMC requirements for revalidation and encourages and enables them to continue to put patients first. Sometimes public and private health care systems go askew and push doctors into putting other things first. This must be resisted. Sometimes individual doctors will have wrong motivations or will fail to maintain their competency and this, too must be rooted out.
It is doubtful whether annual appraisal is the best way to identify doctors with problems, these problems will come to light occasionally during appraisal and then it is very important that appraisers know how to deal constructively but rigorously with such issues.
What is more doubtful is whether organisations are ready to learn from the appraisal process about how best to support their medical staff in delivering quality services and putting patients first. Unless this issue is tackled, appraisal may fail to achieve its full potential benefits
“O would some power the giftie gie us to see ourselves as others see us.” Robert Burns (1759-96)
Appraisal for revalidation has arrived. The job of the appraiser is to enable the appraised to see themselves as others see them. Stripped of all the (necessary?) bureaucratic wrapping surely good annual appraisal is all about a realistic self-assessment of what we have achieved over the last year and how we can improve over the next year. One of the joys (!) of preparing our annual portfolio for appraisal is that it does often remind us of what we have managed to achieve in the last year, often in spite of the rapid changes in our NHS.
Keeping your balance is important, literally and metaphorically. Physically, lack of balance can lead to falls and painful injuries. The old phrase “whilst the balance of his mind was disturbed” reminds us of the importance of mental balance. But what about balancing family and work, thinking and doing, resting and acting, etc. etc.
Two common themes emerge from this metaphor for me. The first is expressed well by the phrases “keeping everything in proportion” and “everything in its (proper) place”. The second, which comes from my cycling experience is that it is much easier to keep my balance when I am moving forwards. This in turn leads to the idea that I need a sense of direction. Otherwise, how do I know which way is “forward”?
Coaching is concerned with balance and many coaches use a metaphor of the balance wheel which consists of a circle with important issues like family, work, recreation, finances, etc. arranged on the radii. Clients are then asked to rate each area from “0″ at the centre where that area is completely unsatisfactory to “10″ at the edge of the circle where that area is completely satisfactory (see chapter 1 of “Practical Management and Leadership for Doctors” for an example). The resulting “wobbly wheel” helps coach and client think about areas where coaching work may be needed.
Coaching is also concerned with setting direction and moving towards our goals. Having sorted out what is important in our lives, how do we build up the good things and leave those that are not helpful behind?
This is the beginning of a New Year. Let’s hope it’s less full of violence and greed than the last! If you are reading this, I hope you have a great new year! I don’t usually make New Year’s resolutions but this year I decided to start a new website to share some of my thoughts in the context of my Quaker faith. If you are interested, you can find it at www.thinkingquaker.co.uk
Whether you are a Christian, of another faith or none, it is good to take a break for reflection. Christmas (despite all the last-minute preparations) is a good time to do that.
Have a happy, reflective Christmas season and enjoy the New Year!
People ask me sometimes for a good introduction to coaching. One of the easiest to understand and put into practice is:
Whitmore, J. (2009) Coaching for Performance. Nicholas Brealey Publishing, London.
Now in its 4th edition, this is an excellent introduction to coaching written by one of the British pioneers in the field. Whitmore’s model derives in part from the sporting world but has been developed for use in management, particularly coaching as a management style which he sees as fundamental to improved performance. His GROW model takes the client through Goals, Reality, Options and Will, the commitment to specific action. I have also found the GROW model useful for structuring clinical and ad hoc management meetings
Jonathan Sacks writes of the “Great Partnership” between Science and Religion. This brings to mind the importance of the human/religious dimension in the practice of medicine. Compassion and (so-called) social and emotional intelligence are as important in practice as knowledge of the facts. If we cannot relate well to our patients and each other we will never make really good clinicians. Our patients (and our colleagues) will not be sure they can trust us. This lack of trust can lead to patients not sharing important information or not giving due weight to advice we may offer. It can lead to poor communication with colleagues, too. We spend a great deal of time in training and continuing professional development on understanding the scientific basis for our practice but very little developing our capacity for good relationships. Coaching is one of many approaches that can help redress this balance.
A recent Medical Director Job Description I saw mentioned the “Seven Principles” of public service as follows:
I was suprised that what many consider to be a cardinal principle of good human relationships, compassion, was not included. Literally it means “feeling with” others. In practice it can be summed up in the “golden rule” of treating other people as we would want them to treat us and it applies to relationships with staff, service users and others with whom we come into contact in our professional lives.
The seven principles all seemed rather dry and emotionless. Surely it is compassion that gives the motivation to all the others.
Viktor Frankl, the Austrian psychiatrist and concentration camp survivor invented “logotherapy”. He argued that
“Once we eliminate from our vision of man the human dimension in which such human phenomena as the will to meaning are located, we must construct, not to say invent, drives and instincts to explain human behaviour – without recognising that by the very nature of such an explanation man’s behaviour actually is dehumanised.” (Frankl 1975)
He recognised three ways in which humans find meaning in their life:
- finding meaning through relationships
- finding meaning in a life’s work or serving a cause
- finding meaning in unavoidable suffering
There is a strong similarity with coaching which also seeks to help people find their unique meaning through improved relationships, achievement and coping with stress and suffering
I have been coaching doctors and others in management positions for over 5 years now. I have been teaching coaching skills through the Education and Training Centre of the Royal College of Psychiatrists (CETC) http://www.rcpsych.ac.uk/training/cetchome.aspx for nearly as long. I am amazed at how helpful coaching can be, particularly for doctors in management positions. Please use the buttons above to find out more about me and more about coaching.