Chief registrar update Dr Orod Osanlou ST6 Clinical Pharmacology and Therapeutics, General Internal Medicine Chief Registrar Warrington Hospital 2016/7 Dr Michelle Cooper ST7 Acute Medicine, General Internal Medicine Chief Registrar Warrington Hospital 2017/8

Background A key recommendation in the Future Hospital Commission report was the need to establish new, senior leadership roles whose focus was on delivering high quality, safe care Recommended a new senior leadership role for doctors in training – the ‘chief registrar’ The Future Hospital Programme (FHP) was set up in 2014 to deliver the recommendations in the 2013 Future Hospital Commission report. The vision of the 2013 Future Hospital Commission report was improving care for medical patients by structuring hospital services around the needs of patients. 11 principles of patient care underpin this approach. The FHC proposed new structures for hospital medical divisions that would help achieve the vision of the future hospital. It recommended establishing the role of chief resident for trainee doctors, from which the role of chief registrar was developed and piloted (modelled on the US system).

Chief registrar scheme A new senior leadership role for trainees that bridges the divide between the junior doctor workforce, senior clinical leaders and managers Now in its second year, following a successful pilot in 2016/17 with 21 chief registrars Target of 50 chief registrars in 2017/18 across the UK Continued growth planned in future years Opened up to other specialities and possibly allied healthcare professionals

About the role Minimum 12-month post 40-50% protected time for leadership and management Aimed at ST5 trainees and above RCP leadership development programme Local mentorship & support Speaking, networking & profile-raising opportunities

Chief registrar priorities Service improvement: Using QI methodology and working with teams across boundaries Morale: Ensuring trainees feel valued and that their voice is heard Workforce transformation: Reorganisation of working patterns to improve conditions Education and training: Improving education, training and induction opportunities, and mentoring trainees Chief registrars deliver a wide range of projects locally in their trusts. Common themes include:

Examples of local initiatives “Patients no longer need to stay in hospital overnight” Facilitating junior doctor forum Improving weekend discharge Establishing ambulatory care and ‘acute hospital at home’ services Redesigning pathways Medical handover and hospital at night Improving discharge summaries Coaching and mentoring trainees Renovating doctors’ mess and introducing ‘mess meetings’ “94% of junior doctors would now recommend their job to others  (compared with 10% previously)”   Here are some examples of projects the 2016/17 cohort implemented and some of the outcomes they have achieved The great thing is that each project is tailored individually to the needs of the local trusts I am sure that you all recognise most of these are common themes and problems in most trusts up and down the country “Demonstrable improvement in morale and perception of training quality”   

Independent evaluation findings Health Services Management Centre, University of Birmingham Positive impact on chief registrars and the individuals they work with Very strong evidence of personal development Enhanced engagement with senior clinical and managerial colleagues Improved morale Contributions to quality and service improvement Effective cross-team collaboration The Health Services Management Centre at the University of Birmingham was commissioned in 2016 to evaluate the impact of the pilot on chief registrars and their organisations. The evaluation findings include… Copy of the evaluation full report and executive summary is available on the RCP website

My time as the chief Warrington Hospital February 2016-January 2017 50% clinical, 50% leadership and management Supervisors NHS Leadership Academy

Chief Registrar Finding my feet Who you know How to get things done

Education and Training Journal Club Teaching for higher medical trainees CMT teaching revamp PACES teaching CMT clinics CMT training Foundation doctors reflections and teaching MEDIC

Other projects Empowering junior doctors Formalising handover Medicines Governance lead PTWR within 14 hours Renovating the doctors mess Estimated date of discharge IT training by doctors abdominal paracentesis day case safety Hospital at night Ibleep improvements Higher medical trainees maternity leave Improving the higher medical training rota Medically optimised patients Foundation mentorship scheme

Discharge Ward Rounds Poor weekend bed flow within directorate of medicine Acute admissions prioritised, IP often overlooked On calls teams too busy Perfect for chief registrar!

Discharge Ward Rounds I had experience from RLBUHT and AUH Identified barriers: no staff dedicated to discharges Pharmacy only open for 2 hours? Approached chief of medicine with proposal Wrote an SOP Utilised capacity from myself and maternity leavers

Discharge Ward Rounds Started 8 week trial Dedicated higher medical trainee for discharges Pharmacy open from 1000-1600 for discharges Successful trial resulted in full implementation

Discharge Ward Rounds Data still being analysed Measure Days Baseline discharges/weekend 3.5 Baseline discharge days saved/weekend 4.6 Measure Days Intervention discharges/weekend 9.3 Intervention discharge days saved/weekend 17.2

Discharge Ward Rounds Intervention has resulted in ~ 13 more bed days saved a week Extrapolated would result in >650 more bed days saved a year With cost of NHS bed for a medically optimised patient estimated to cost £2731, there is a theoretical saving of ~ £150,000 per annum - After taking into account locum costs to staff the shifts 1.https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/261154/nhs_reference_costs_2012-13_acc.pdf

How I have developed? Better understanding of the system Street wise Networking Opportunities e.g. FHP guest editor Teaching programme FMLM Teaching programme NHS Leadership Academy 20+ posters/oral communications/publications

Next steps Continue development MSc Further leadership projects locally Collaborations with other chief registrars Mentoring 2 Chief Registrars Just because I am not a chief registrar anymore, doesn’t mean I don’t think like one….. Once a chief registrar, you're a chief registrar forever

These are themes that run throughout chief registrars’ work

Chief Registrar Current Chief Registrar at Warrington Hospital In post since August 2017 (approx. 1 month) 1 year post ST7 in Acute Medicine Approx. 50% clinical- 50% leadership and management

Why Did I Apply? Role promoted by TPDs Act as an advocate for junior doctors at senior management meetings Improve junior doctors morale Opportunity to develop leadership skills Quality Improvement Projects

Things I have already done Presented at the local induction to introduce the role of Chief Registrar to trainees Supported IT training sessions Providing medical input and “real time” user advice Encouraged communication between junior doctors Email Whatsapp groups (No clinical information obviously!!)

Things I have already done Negotiating CT requesting rights for CMTs on their behalf Encouraged involvement of junior doctors in quality improvement projects Support and guidance Attended senior management meetings Voiced junior doctors concerns Promoted meetings with the medical director and assistant medical director Historically poor attendance/little engagement

Current Projects at WHH Currently involved/leading on a number of quality improvement projects including: Introduction of “Hot clinics” Primarily registrar led with consultant input CMT Trainees can attend Introduction of electronic medical take list Selected the computer program that will work for both A&E and medical registrars Liaising with A&E and medical registrars to ensure collaborative working on this project

Current Projects at WHH More projects: Red to Green Pilot NHS Improvement Scheme- visual management system to assist in the identification of wasted time in a patients journey (1) Ongoing work with Medical Handover Structured format introduced Redesigned the attendance sheet to include template of prompts Reference (1) https://www.england.nhs.uk/south/wp-content/uploads/sites/6/2016/12/rig-red-green-bed-days.pdf NHS improvement Scheme-visual management system to assist in the identification of wasted time in a patient’s journey. A Red day is when a patient receives little or no value adding acute care. A Green day is when a patient receives value adding acute care that progresses their progress towards discharge. A Green day is a day when everything planned or requested gets done. A Green day is a day when the patient receives care that can only be in an acute hospital bed.

Current Projects at WHH Weekly registrar teaching programme Frailty Use of Edmonton score on admission to identify frail patients Collaborating with Orod to ensure continuation of previous changes implemented prior to my appointment

Would I Recommend the Chief Registrar Role YES If you don’t have one in your trust- GET ONE! Trust information, sample job description/person specification and business case available Encourage trainees to apply Flyers are available If you do have one- USE US! We can help! Find current appointments at www.rcplondon.ac.uk/projects/outputs/chief-registrar-2017-18-recruitment-guidance Contact RCP regional managers

Chief registrar scheme “The chief registrar scheme has provided me with the time and support to work on ideas to improve service provision, patient safety and intercollegiate relationships within my trust” - Dr Alexandra Ewence, chief registrar 2016/17 Recruitment for the next cohort – 2018/19 – opens in August Contact the chief registrar team for more information and to register interest Recruitment for the 2018/19 cohort open now

Twitter: @RCPFutureHosp / #chiefregistrar RCP chief registrar scheme Website: www.rcplondon.ac.uk/projects/future-hospital-chief-registrar-scheme Email: chiefregistrar@rcplondon.ac.uk Twitter: @RCPFutureHosp / #chiefregistrar